Bloody Nipple Discharge in Infants

Abstract

Bloody nipple discharge is extremely rare in children. The etiology and pathophysiology remain uncertain, with the most common cause being mammary ductal ectasia. Despite its stressful course to the parents, it is generally a benign condition with a spontaneous resolution. A 3-monthold and a 6-month-old female infants were admitted to our clinic because of bloody discharge from the nipples. Bilateral fibrocystic changes were detected in the ultrasonographic examination of the infants, whose physical examination and hemogram, prothrombin time, aPTT, estradiol levels were normal. The hemorrhage ended within one month in the follow-up of both cases, but in our 6-month-old patient, bleeding recurred once again after 10 months. As a conclusion, in cases of bloody nipple discharge, which is seen rarely during infancy, the bleeding usually disappears spontaneously without any intervention. After detailed evaluation of the cases, they should be followed conservatively.

Keywords

• Bleeding
• ductal ectasia
• infant
• nipple discharge

Bebeklerde Meme Başından Kanlı Akıntı

Abstract

Çocuklarda meme ucu kanlı akıntısı çok nadir görülmekte olup, etyolojisi ve patofizyolojisi bilinmemektedir. En sık neden duktal ektazidir. Ebeveynleri endişelendirmesine rağmen sıklıkla spontan olarak gerileyen selim bir durumdur. Memeden kanlı akıntı nedeniyle kliniğimize başvuran 3 ve 6 aylık iki kız bebeğin yapılan fizik muayenelerinde özellik saptanmadı. Hemogram, aPTT, prothrombin zamanı ve estradiol değerleri normal bulunan olguların yapılan ultrasonografilerinde duktal ektaziye bağlı bilateral fibrokistik değişiklikler görüldü. Her iki olgunun takibinde kanamaların bir ay içinde kaybolduğu saptanırken, 6 aylık olan olgumuzda 10 ay sonra bir kez daha kanama tekrar etti. Sonuç olarak sıklıkla duktal ektazi sonucu gelişen meme ucu kanlı akıntısında kanama, tedaviye gerek kalmadan kendiliğinden kaybolmaktadır. Olgular detaylı bir şekilde değerlendirildikten sonra konservatif olarak takip edilmelidir.

Keywords

• Çocuk
• duktal ektazi
• kanama
• meme ucu akıntısı

References

1. 1. De Praeter C, De Coen K, Vanneste K, Vanhaesebrouck P. Unilateral bloody nipple discharge in a two-month-old male. Eur J Pediatr 2008;167:457-9.
2. 2. Pampal A, Gokoz A, Sipahi T, Dogan H, Ergur AT. Bloody nipple discharge in 2 infants with interesting cytologic findings of extramedullary hematopoiesis and hemophagocytosis. J Pediatr Hematol Oncol 2012;34:229-31.
3. 3. Méndez-Gallart R, García-Palacios M, Bautista-Casasnovas. Spontaneous brownish nipple discharge in a 9-year-old boy. Pediatr Dermatol 2017;34:361-2.
4. 4. Jung Y, Chung JH. Mammary duct ectasia with bloody nipple discharge in a child. Ann Surg Treat Res 2014;86:165-7.
5. 5. Trojanowska-Szostek M, Kulik-Rechberger B. Bloody nipple discharge in an 3,5-month-old boy. Pediatr Endocrinol Diabetes Metab 2013;20:30-2.
6. 6. Leung AK, Kao CP. Mammary duct ectasia: a cause of bloody nipple discharge. J Natl Med Assoc 2004;96:543-5.
7. 7. Kaplan R, Hoda SA, Hoda RS. Cytological evaluation of bloody nipple discharge fluid. Diagn Cytopathol 2013;41:183–5.
8. 8. Acer T, Derbent M, Hiçsönmez A. Bloody nipple discharge as a benign, self-limiting disorder in young children: A systematic review including two related case reports. J Ped Surg 2015; 50:1975-82.

9. 9. Gupta V, Yadav SK. Infantile bloody nipple discharge: a case report and review of the literature. Afr J Paediatr Surg 2009;6:63-4.
10. 10. Paula IB, Campos AM. Breast imaging in patients with nipple discharge. Radiol Bras 2017;50(6):383-8.
11. 11. Ascaso Matamata ÁM, Amiguet Biain M, Morales Ferruz R, Sobrevia Elfau MT, González García G. Duct ectasia, an infrequent condition in childhood: A case report. Arch Argent Pediatr 2018;116(6):782-4.
12. 12. Bayrak IK, Yalin T, Nural MS, Ceyhan M. Mammary duct ectasia in infant breast with bloody nipple discharge: sonographic findings. J Clin Ultrasound 2008;36:229-30.
13. 13. Moon S, Lim HS, Ki SY. Ultrasound findings of mammary duct ectasia causing bloody nipple discharge in infancy and childhood. J Ultrasound Med 38:2793–2798.
14. 14. Zegpi MS, Downey C, Vial-Letelier V. Mammary duct ectasia in children: A case report. Rev Chil Pediatr 2015;86:287-90.
15. 15. Aydın R, Gul SB, Polat AV. Detection of duct ectasia of mammary gland by ultrasonography in a neonate with bloody nipple discharge. Pediatr Neonatol 2014;55:228-30.
16. 16. Harmsen S, Mayatepek E, Klee D, Meissner T. Bloody nipple discharge (BND) in an 8 month old girl and a 9 months old male— rational diagnostic approach. Klin Padiatr 2010; 222:79-83.