Differential Diagnosis for Breast Pain
- Single most likely diagnosis
- Cyclic mastalgia: This is the most common cause of breast pain in premenopausal women. The patient's symptoms of persistent right-sided breast pain, particularly with localized tenderness immediately lateral to the areola, and the absence of any other alarming features, make cyclic mastalgia a likely diagnosis. The fact that her last menstrual period was 2 weeks ago and she is on oral contraceptives, which can sometimes affect breast tenderness, also supports this diagnosis.
- Other Likely diagnoses
- Fibrocystic changes: These are very common in women of reproductive age and can cause breast pain, especially if there are palpable cysts or fibrous tissue. The dense breast tissue noted on examination could be consistent with fibrocystic changes.
- Mastitis or periductal mastitis: Although less common without signs of infection or skin changes, mastitis could still be considered, especially if the pain is localized and severe. The patient's lack of fever and absence of skin changes make this less likely but still a consideration.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed)
- Breast cancer: Although the patient's age and the nature of her pain (cyclic and related to menstrual cycle) make breast cancer less likely, a family history of breast cancer (even at age 58) necessitates careful consideration and possibly further evaluation, such as imaging.
- Inflammatory breast cancer: This rare and aggressive form of breast cancer can present with pain, swelling, and skin changes, although the latter two are not present in this case. The absence of typical signs does not rule out this diagnosis entirely.
- Rare diagnoses
- Pectoralis muscle strain: Although not directly related to breast tissue, strain of the pectoralis muscle could refer pain to the breast area, especially if the pain is exacerbated by movement or pressure on the muscle.
- Costochondritis (Tietze's syndrome): Inflammation of the cartilages that connect the ribs to the sternum can cause chest pain that might be mistaken for breast pain, especially if the pain is located near the sternum or radiates to the breast area.
- Thyroid disease: Sometimes, thyroid disorders can cause breast pain, although this would typically be accompanied by other symptoms of thyroid dysfunction.