>>>Dr. Harness: When I review reports with patients, particularly ultrasound reports,
often it may say right in the body of the report “dilated ducts”.
Wow, that gives the patients’ attention “good grief Dr. Harness, what are dialated
ducts and what are they are about?”
Well, first of all dialated ducts are typically diagnosed with ultrasound.
It is the best technology we have, sort of putting a catheter inside a duct in the nipple
and squirting some dye in.
It is the best technology that we have to see the ductal system of the breast and to
see if there is any pathology or abnormalities associated with the ductal system.
Now when would these typically come up?
Well, usually it comes up if the patient comes in complaining of a nipple discharge.
The nipple discharge can consist of blood, of a greenish fluid is a good example, or
very occasionally almost like a toothpaste and silvery paste-like sort of discharge.
So the ultrasound examination becomes really key in making a non-ductogram if you will,
a non-little catheter in the duct diagnosis of what is going on.
So ducts can dialated up for a variety of reasons, of course if a patient is pregnant,
her ductal system is going to dilate up in order to deliver milk out, so we are not talking
about that here.
If there is a narrowing of the ductal system, typically seen with fibrocystic changes of
the breast, particularly in women in their 40s, the ducts coming up to that narrowing
dilated up, in fact if the duct gets pinched off by the process, the duct can dilate up
so much that it forms a cyst.
Another reason the ducts can dilate up is if there is a little overgrowth going on inside
the duct called an intra (meaning inside) ductal (inside the duct) papilloma (benign
overgrowth) can then sort of partially obstruct the ductal system and cause it to dilate up.
Can you see dilated ducts with in situ breast cancer, you can indeed, not very typical.
What do we do about dialated ducts?
One more thought before I get into that, there is an energy called ductal ectasia, big fancy
in medical word (ectasia meaning dilatation).
Ductal ectasia that can cause the ducts upto dilate up.
This can be seen in people as young as children well up into adult life.
The cause or the medical term for that is etiology.
The cause for ductal ectasia is unknown.
There are some thought that may be there are some chronic inflammation going on and with
this unusual diagnosis of ductal ectasia, you can get a nipple discharge, some time
almost like a toothpaste-like discharge.
So what we do about the dilated ducts?
Frankly, we may do nothing.
If the ductal system is discharging out through the nipple, then a ductogram is indicated.
This is a very very final catheter that a radiologist can thread down into the duct
that is discharging.
Squirt a little dye in and see what is underlying and we can visualize the ductal system that
way.
In most instances, you actually then want to operate because often you find one of these
benign intraductal papillomas and surgically want to remove that by an incision around
the edge of the aureola.
So, what is the take home message?
The take home message is by and large dilation or dilatation, if you will, of the ducts is
a benign process often associated with a nipple discharge can be seen with fibrocystic changes
of the breast, ductal ectasia or intraductal papillomas and very unusual associated with
in situ breast cancer.
As always, if this is the case for you, please get yourself into the hands of a multidisciplinary
team used to handling this problem.
*****
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