Case 28 continued

With this appearance and the history of purulent discharge, this most likely represents infection. The major diagnosis also in the differential when there are signs of inflammation is inflammatory carcinoma. In general, the patient is treated with antibiotics and followed until resolution of signs and symptoms of infection. If these do not resolve, repeat imaging and biopsy are performed to evaluate for inflammatory cancer, which is much less common than mastitis.

Papilloma is the most common cause of bloody nipple discharge, but is unlikely to generate frank pus. If the trabecular thickening were throughout the breast, then XRT might have been a consideration, but one must invoke infection given the history.

Is ultrasound indicated at this time?

• yes
• no