Presentation
Unilateral, persistent, spontaneous bloody discharge of the right nipple.
Patient Data
Right breast mammogram.
Breast ductography was performed despite the challenges posed by the inverted nipple, given the persistent bloody discharge. Cannulation was successful. Findings revealed a focally dilated duct within the nipple, with a cauliflower filling defect. A tubular filling defect was seen posterior to the mass. The mass likely obstructed the duct, leading to clotting and observed discharge.
Right breast ultrasound with color doppler images immediately following ductography was also performed, which demonstrated a hypervascular mass just behind the nipple associated with intraductal tubular avascular debris.
Case Discussion
The combination of ductography and ultrasound imaging confirmed the presence of an intraductal mass as the source of the patient’s symptoms. Conventional mammography did not reveal any abnormalities, emphasizing the importance of ductography in cases of pathologic nipple discharge. The patient’s inverted nipple, while a challenge for ductography, did not prevent successful cannulation and imaging, leading to the diagnosis. The patient underwent an ultrasound-guided core biopsy immediately after ductography with pathology results of benign large duct papilloma with no atypia or malignancy. Subsequently, a lumpectomy was also performed, which confirmed the same pathology results.
Co-author: Aswen Sriranganathan, a medical student at the University of Ottawa.
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