Published 22 July 2009, doi:10.1136/bmj.b2553
Cite this as: BMJ 2009;339:b2553

Practice

Lesson of the Week

An underdiagnosed cause of nipple pain presented on a camera phone

O L Holmen, foundation house officer 1, B Backe, professor in obstetrics2

1 Department of Obstetrics and Gynecology, St Olav’s University Hospital, Trondheim, Norway , 2 Department of Laboratory Medicine, Children’s and Women’s Health, Norwegian University of Science and Technology, Trondheim

Correspondence to: O L Holmen oddgeir.lingaas.holmen@gmail.com

Ordinary camera phones deliver high quality photographs, which can help doctors make uncommon diagnoses

The first 150 words of the full text of this article appear below.

Raynaud’s phenomenon of the nipple is a possible diagnosis in lactating women with severe nipple pain. It is characterised by vasospasm of the arterioles causing intermittent ischaemia, which is manifested as pallor, followed by cyanosis as the venous blood is deoxygenated, and then erythema when reflex vasodilatation occurs. Because symptoms do not appear straight after delivery, mothers may seek the help of their GPs rather than of hospital clinicians. It is important, therefore, to educate primary healthcare workers about severe nipple pain, especially since prompt recognition and treatment allow mothers to continue breastfeeding.

A 25 year old woman sought antenatal obstetric care early in the second trimester of her first pregnancy, reporting frequent episodes of extreme bilateral nipple pain. A typical episode lasted between 5 and 15 minutes and was so painful as to bring her to tears.

She described how the pain altered in tandem with a triphasic colour . . . [Full text of this article]


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Relevant Article

Vasospasm of the nipple–a manifestation of Raynaud's phenomenon: case reports
Laureen Lawlor-Smith and Carolyn Lawlor-Smith
BMJ 1997 314: 644. [Extract] [Full Text]

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