Duct ectasia

Case contributed by Dr Garth Kruger


Spontaneous nipple discharge from the left breast.

Patient Data

Age: 60
Gender: Female

The patient has duct ectasia. The ectatic duct can be followed out right onto the opening on the nipple.

Notice how on the ML mag view, the contrast layers out almost like teacups in microcystic adenosis of the breast. The principle is the same.

Case Discussion

Ductography only really serves a purpose with a single discharging duct. If there are multiple discharging ducts or bilateral symptoms, the etiology is idiopathic or constitutional and ductography serves no purpose.

There is a poor correlation between the physical appearance of the discharge and the findings on ductography. The traditional impression that the "bloody" discharge is somehow more sinister is not true. Most discharges described as "bloody" are in fact dark brown on careful examination.

When performing ductography, visualization of the leaky duct can be improved by dropping a small drop of contrast onto the nipple and using it as a lens to aid visualization. Try it. It works. And with ductography as in sialography, do not use brute force and ignorance. Once you have traumatized the duct orifice your chances of success are close to zero.

Post injection, do magnified views. You see so much more.

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