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Vakul Aren
Vakul Aren, Doctor
Category: Medical
Satisfied Customers: 3367
Experience:  MBBS,DTM&H,30 years of experience
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I have left breast pain and swelling and pain under my left

Customer Question

I have left breast pain and swelling and pain under my left arm for over 2 months, my nipple is now raw feeling and my breast itches, but no rash. I can barely wear a regular bra because it is so uncomfortable. mamogram ultra sound and MRI all came back normal, I have no medical history because I am adopted. was told by a surgeon that she cant do anymore for me, so where do I go from here.....I know in my gut something is wrong, but no one can find anything.
Submitted: 2 years ago.
Category: Medical
Expert:  Ken replied 2 years ago.
Hello,

Are there associated symptoms like fever/ redness of the overlying skincough? Does pain increase or decrease with food, particular posture?
Customer: replied 2 years ago.

no the pain is pretty much constant, no fever, no redness and it doesnt increase or decrease with food or posture just the pain and swelling and itching and the pain under my arm

 

Expert:  Ken replied 2 years ago.
Hello,

I can understand your anxiety.

Negative ultrasound, mammogram and MRI rule out any abnormality at the breast parenchyma.

We need to consider few other causes. I would like to consider inflamed nodes at the arm pit/ irritation of the nerve at the spine/ inflammation of the costo-chondral junctions/ inflammation of esophagus/ inflammation at the left lung or pleura/ muscle sprain/ cardiac element.

We need to to investigate it further for sure. Few investigations like blood tests/ MRI for cervical and dorsal spine/ chest x ray/ ultrasound for axilla/ EKG/ upper GI scopy will give us more answers.

Till then - Tylenol, Motrin/ warm compress may help reduce the pain and discomfort.

Please do not worry, you will be fine soon. God bless

Customer: replied 2 years ago.

I am not sure what kind of doctor to go to for these tests, I have seen my family doc, OB/GYN and a surgeon, where do I go from here, and in english, what do any of those conditions mean?

Expert:  Ken replied 2 years ago.
Hello,

Internal medicine doctor is preferred.

I am sorry for those medical terms. Let me explain in a bit detail.

Inflamed nodes are enlarged lymph nodes {they act as front line soldiers to fight infection and enlarge when there is inflammation or infection in the region drained by them}.

Irritation of the nerve at the spine - The spine consists of vertebrae and intervertbral discs { soft tissue cushion if I may say }. The cord or bunch of nerves in simple word passes through the spinal canal { formed by vertebral body in front and ring like posterior part around }. Any bone spur of displacement or bulge of the disc cause pressure over the cord which results in symptoms like pain / numbness / tingling due to nerve irritation. The nerves leave the spinal canal through small rounded openings laterally. Pinching of these nerve roots can occur at this level too.

Inflammation of the costo-chondral junctions - junction where ribs meet the sternum {front of chest}.

Inflammation of esophagus or food pipe.

Inflammation at the left lung or pleura {covering over the lung}.

Cardiac element {reduced blood flow to the heart can present with pain}.

Best



Customer: replied 2 years ago.



Inflamed nodes are enlarged lymph nodes - dont have any swelling in my under arm, nor is there a lump.....would the pain alone be enough for a doctor to order an ultra sound?

Irritation of the nerve at the spine - Thepine consists of vertebrae and intervertbral discs { soft tissue cushion if I may say }. - I have talked with a chiropractor and she didnt see anything that would be causing the pain....I see her montly just because I know it promotes good posture.....etc..
Inflammation of the costo-chondral junctions - i read several articles that said this condition does not cause swelling.....is that incorrect??


Inflammation of esophagus or food pipe. - have no issues with eating, the surgeon mentioned this and dismissed it because i have had no issues with food, heartburn, or indigestion

Inflammation at the left lung or pleura {covering over the lung}. - would this cause breathing issues...I am working out and have no issues with being out of breath or chest pain or fatigue


Cardiac element {reduced blood flow to the heart can present with pain}.

Best

Expert:  Ken replied 2 years ago.
Hello,

I think there is some technical issue with the software.

I see that my reply to you has been sent as your reply to me!

Do you want me to explain any thing in more details?
Customer: replied 2 years ago.

no i actually copied and pasted your answers and added my comments to it, Im sorry I should have used a different font,

 

Inflamed nodes are enlarged lymph nodes - dont have any swelling in my under arm, nor is there a lump.....would the pain alone be enough for a doctor to order an ultra sound?

Irritation of the nerve at the spine - Thepine consists of vertebrae and intervertbral discs { soft tissue cushion if I may say }. - I have talked with a chiropractor and she didnt see anything that would be causing the pain....I see her montly just because I know it promotes good posture.....etc..
Inflammation of the costo-chondral junctions - i read several articles that said this condition does not cause swelling.....is that incorrect??


Inflammation of esophagus or food pipe. - have no issues with eating, the surgeon mentioned this and dismissed it because i have had no issues with food, heartburn, or indigestion

Inflammation at the left lung or pleura {covering over the lung}. - would this cause breathing issues...I am working out and have no issues with being out of breath or chest pain or fatigue


Cardiac element {reduced blood flow to the heart can present with pain}.

Expert:  Ken replied 2 years ago.
Ohh..

Well - Nodes when inflamed may not show increase in size {if inflammation is less or immunity is strong enough to curtail it}.

You are right - Swelling is less likely with irritation of the nerve. But one may feel that there is swelling due to tenderness and numbness both together.

Generally lung or pleural inflammation do present with difficulty in breathing {seen when there is mass effect over the lung parenchyma by the overlying inflammation}. This may not be the case always. they may present with pain alone.

Best

Customer: replied 2 years ago.

so do you think it would be benefitial to try and get an ultra sound of the lymphnode, or is that something that would have been seen in the breast MRI?

 

also, so you thing its worth pursuing the lung route?

 

I am very frustrated with no answers for something that is obviously wrong, I just dont know where to go for answers

 

 

Expert:  Ken replied 2 years ago.
Hello,

I do understand your frustration.

We need to get answers for sure so that treatment can be planned.

If i were you Next step would be - chest x ray/ ultrasound for arm pit {MRI for breast may miss arm pit region}/ MRI for spine.

good luck
Customer: replied 2 years ago.
Relist: Other.
i honestly just dont feel that i got any new information, i have already gone down the roads that were given and still dont feel like i have a new way to receive a diagnosis Ken was very helpful, just didnt provide any new information
Expert:  Ken replied 2 years ago.
Thank you for your kind words.

I tried to do best I could.

I will opt out so that some other expert can help you better.

God speed
Customer: replied 2 years ago.

i understand that you have done as much as you can, i realize that i might be a special case, but i just need to figure out where to go to find out what is wrong. I appreciate your help

 

 

Expert:  Vakul Aren replied 2 years ago.
Dear customer, Greetings.I feel that you should consider initial stages of Paget's disease of the breast and nipple or a Inflammatory breast cancer as a povisional diagnosis.This is a potentially serious ailment which may be secondary to a malignancy of the breast/nipple.Other causes of itching would include allergy/dry skin/neurodermatitits/hormonal causes/eczema and are easily diagnosed by a Dermatologist.A mammography and a skin biopsy may help your doctor confirm the diagnosis.A consultation with a good Oncologist who is familiar with this condition would help.The disease in the initial 6-7 months may present as burning/irritation of the breast and nipple.Cytopathology of nipple skin biopsy and any nipple discharge (MRI scan and mammography may be normal in the initial stages of the disease) would be helpful in pinpointing the disease.A good general surgeon with experience with the disease would also help.Other symptoms of the disease may become apparent with passage of time,but due to the serious nature of the problem seeking help early in confirming or excluding these diseases is essential.
Customer: replied 2 years ago.

so a normal MRI doesnt necessarily mean that something more serious is wrong, the MRI, ultra sound and mamogram all came back normal, if they did a biopsy, what do they biopsy, there is nothing showing up on any of my tests?

 

also, I though inflammatory breast cancer started with the skin rash? so with no rash, it is still a possibility?

Expert:  Vakul Aren replied 2 years ago.
There would only be burning,tingling ,itching,increased sensitivity and pain in the nipple area and part of the breast .Gradually some induration/redness or crusting of the skin may be seen.Symptoms are reported upto 6months before the diagnosis is made.The dermatologist or Oncologist would look into any redness,scaling or flaking of the skin .In some cases even that is not there,there may only be mild irritation and itching.
http://www.breastcancertreatment.in/paget's_disease1.htm and
http://www.cancer.gov/cancertopics/factsheet/Sites-Types/paget-breast
are sites which makes interesting reading on the subject.
Customer: replied 2 years ago.
what about inflammatory breast cancer......would a normal MRI rule that out??
Customer: replied 2 years ago.
Relist: Incomplete answer.
Expert:  Vakul Aren replied 2 years ago.
I am sorry I had to go to the hospital to attend a emergency call.Hence the delay in answering.The MRI Scan will complement the digital mammography and ultrasound Scan in ruling out inflammatory breast cancer(IBC).Early stages and very small cancers may still be missed initially but will be detected as they grow in size.Biopsy including a piece of the skin will help if there is a suspicious area.
Customer: replied 2 years ago.

so my next step should be a biopsy??

 

Expert:  Vakul Aren replied 2 years ago.
It would help if you can see a Breast cancer Physician,a specialist who may be found in the larger tertiary care centres.Further investigations and tests may then be routed through him or the Oncologist.It would help to approach a Oncologist if you cannot find a breast cancer specialist.He wold then guide you as to what is required to rule out malignancy in your case.
http://www.ibcresearch.org/ is a site of interest.
Expert:  Vakul Aren replied 2 years ago.
Would you need any more information ?I am here to help you .

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