Kelly et al reported a diagnostic approach for evaluating an infant with a bloody nipple discharge. It is important to differentiate the majority of benign conditions from the small minority of serious disorders. The authors are from the University of New Mexico in Albuquerque.


Patient selection: infant with blood nipple discharge


Common conditions associated with a bloody nipple discharge in an infant:

(1) mastitis

(2) excessive hormone production, especially from a pituitary tumor

(3) mammary duct ectasia


The recommended workup is:

(1) clinical exam, especially whether unilateral or bilateral

(2) Gram stain and culture of the discharge for detection of mastitis

(3) serum levels of prolactin, estradiol and TSH (thyrotropin)

(4) ultrasound


The authors felt that detection of a palpable mass was helpful in initial triage other than for targeting with ultrasound and for monitoring during followup.


If serum concentrations of hormones are elevated, then MRI of the pituitary and brain is performed.


If no significant problems are identified then the child should be followed and the parents reassured.


Indications for surgical consult:

(1) abnormal or suspicious mass on ultrasound

(2) palpable mass that fails to resolve within 9 months

(3) pituitary or brain mass


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