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| ==Causes== | | ==Causes== |
| === Causes Related to the Breast=== | | === Common causes=== |
| * Fibrocystic changes
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| :* Increased number of cysts or fibrous tissue in otherwise normal breasts
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| :* Can be associated with pain or [[nipple]] [[discharge]] - [[fibrocystic disease]]
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| :* If fibrocystic changes are cause of pain- found in 50-90% asymptomatic women
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| :* Hormonal etiology - pain often cyclic; most severe during luteal phase
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| :* Tissue edema/water retention with dilated/blocked ducts - not proven
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| *[[Mastitis]] or breast abscess
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| :* Acute onset, usually due to Staphylococcus aureus (S. aureus) or streptococci
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| :* [[Erythema]], local [[tenderness]] induration
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| :* Most common in lactating women
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| * Pendulous breasts
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| :* Pain due to stretching of Cooper’s ligaments
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| * [[Hidradenitis suppurativa]]
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| :* Can involve the breast
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| :* Presents with painful breast nodules
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| === Causes Unrelated to the Breast ===
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| * Trauma to chest wall
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| * Fat necrosis
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| :* Usually induced by trauma
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| :* Tender, firm mass, +/- calcification on mammogram
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| * [[Costochondritis]]
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| * [[Intercostal neuralgia]]
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| :* Usually due to a [[respiratory infection]]
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| * [[Pleuritic pain]] from underlying pulmonary/pleural disease
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| * Thoracic spine arthritis
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| * Referred chest pain
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| :* [[Gallbladder disease]]
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| :* [[Ischemic heart disease]]
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| ===Flowchart===
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| {{familytree/start}}
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| {{familytree | | | | | | | | | | | | A1 | | | | | | | |A1=Breast Pain}}
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| {{familytree | | | | | | | | | | | | |!| | | | | | }}
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| {{familytree | | | |,|-|-|-|-|-|-|-|-|+|-|-|-|-|-|-|-|-|-|.| }}
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| {{familytree | | | B1 | | | | | | | B2 | | | | | | | |B3| |B1= Cyclic Pain|B2=Localized Tenderness|B3=Generalized Tenderness}}
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| {{familytree | | | |!| | | | | | | | |!| | | | | |,|-|-|-|^|-|-|-|.| | }}
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| {{familytree | | | C1 | | | | | | | C2 | | | | C3 | | | | | | C4| |C1=Premenstural<br>Syndrome|C2=Trauma<br>Mastitis<br>Abscess<br>Herpes Zoster<br>Breast Fibroadenoma|C3= Fibrocystic Diseases<br>Pregnancy<br>Alcoholism<br>Caffeine|C4=Digitalis<br>Methyl-Dopa<br>Spironolactone<br>Chlorpromazine<br>Estrogens<br>Oral Contraceptives}}
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| {{familytree/end}}
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| ==References== | | ==References== |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2] Hilda Mahmoudi M.D., M.P.H.[3]
Overview
Two thirds of breast pains are cyclical and one third have non cyclical cause.[1]
Cyclical breast pain is very often associated with fibrocystic breast changes or duct ectasia and believed to be caused by aberrations in dynamic hormonal changes mainly involving prolactin response to thyrotropin. Some degree of cyclical breast tenderness is normal in the menstrual cycle, and is usually associated with menstruation and/or premenstrual syndrome (PMS).
Noncyclical breast pain has various causes and is harder to diagnose.It is more likely to be unilateral and variable in its location in the breast.Some degree of non-cyclical breast tenderness can normally be present due to hormonal changes in puberty (both in girls and boys), in menopause, during pregnancy and breastfeeding. Other causes of non-cyclical breast pain include alcoholism with liver damage (likely due to abnormal steroid metabolism), mastitis, shingles and some medications.
Causes
Common causes
References
- ↑ Davies EL, Gateley CA, Miers M, Mansel RE. The long-term course of mastalgia. J R Soc Med 1998; 91:462.