Multimodality evaluation and ultrasound-guided aspiration of a biopsy-proven inspissated clogged milk duct: a case report.

Abstract

Background: Despite the benefits of breastfeeding to both infant and mother, many mothers find breastfeeding difficult secondary to many complications such as pain, breast engorgement, mastitis, and clogged milk ducts. The latter is typically treated conservatively with techniques such as gentle massage, breast pumping, and compresses. When conservative therapies are unsuccessful, more invasive options are considered to ensure the continuation of breastfeeding.

Case description: A 34-year-old lactating female presented with a 3-month history of worsening left breast and nipple pain radiating to the left upper outer quadrant, not relieved with conservative therapies. The physical exam revealed a small indentation and a small palpable nodule of the left nipple. There was no associated erythema or redness. Targeted ultrasound and subareolar magnification views revealed findings most consistent with a probably benign inspissated clogged milk duct. Given the patient's history, inability to express milk from the left breast, and plan to lactate for another year, ultrasound-guided aspiration was desired. Post-aspiration images demonstrated complete resolution of the nipple mass. Pathology revealed blood and proteinaceous material, in keeping with the diagnosis of inspissated clogged milk duct. Following the procedure, the patient's symptoms resolved completely.

Conclusions: We present a case of irretractable milk duct plug treated with ultrasound-guided direct aspiration of the plug with complete resolution and minimal side effects to the patient.