Pediatric emergency medicine trisk 0428 0428

TABLE 16.4
IMPORTANT HISTORICAL AND PHYSICAL EXAMINATION
COMPONENTS IN THE EVALUATION OF A BREAST LESION
History
Onset and duration of lesion
Pain
Nipple discharge
Relationship of lesion with menses
Complete menstrual and sexual development history, including sexual activity
and previous pregnancies
Family history of breast disease
Diet
Medications and illicit drugs
Concomitant medical disorders
Systemic symptoms: fever, weight loss, sweating, headaches, visual changes
Physical Examination
Breasts: symmetry, skin appearance, temperature, areola, nipples, secretions,
masses, chest wall, axillae
Lymph nodes
Hair distribution
Genitalia

Diagnostic Testing
The majority of patients presenting to the ED will not require intensive laboratory
or radiologic testing. All postmenarchal girls should have a pregnancy test
performed; breast tenderness and swelling are among the earliest signs of
pregnancy. The most helpful test in the emergency setting is breast
ultrasonography, which is useful in distinguishing between masses and cystic
lesions as well as the presence of abscess with mastitis. Other imaging studies are
rarely helpful. Mammography is of little value in children and adolescents, owing
to the high proportion of fibroglandular tissue within the breast. Chest

radiography is rarely helpful, except when the examiner elicits signs and
symptoms from the lungs or chest wall that may be referred to the breast. If