JohnFerguson Posted June 26, 2014 Share Posted June 26, 2014 A young male presents with c/o small, tender breast lump. Thinking gynecomastia. Do you order Mammogram and U/S or just U/S to rule out other pathology? Link to comment Share on other sites More sharing options...
winterallsummer Posted June 26, 2014 Share Posted June 26, 2014 http://emedicine.medscape.com/article/120858-workup Mammography is going to be more specific. Haven't dealt with this but the above link gives a good overview and some other considerations. Link to comment Share on other sites More sharing options...
cupojava Posted June 26, 2014 Share Posted June 26, 2014 ultrasound and urine drug test Link to comment Share on other sites More sharing options...
cbrsmurf Posted June 26, 2014 Share Posted June 26, 2014 Before you go further with imaging, consider the age. If patient is still growing, likely just pubertal changes. How long has it been there? Consider epidermoid cyst or local infection. Is it firm and mobile? Unilateral or bilateral? Medications? If it were bilateral (edit, unilateral), firm, and mobile, I would consider u/s, hormone levels, and check testicles as well for masses. Would probably just observe if it didn't have the aforementioned characteristics. Link to comment Share on other sites More sharing options...
Guest Paula Posted June 26, 2014 Share Posted June 26, 2014 ultrasound and urine drug test That was my initial thought too. If a marijuana user that just may be the culprit. Of course.....have to rule out all the bad stuff....like mrs smurf says. Link to comment Share on other sites More sharing options...
Guest JMPA Posted June 26, 2014 Share Posted June 26, 2014 you need a thorough hx followed by a thorough exam with detailed discription. imaging is only supportive Link to comment Share on other sites More sharing options...
ehubbs Posted June 29, 2014 Share Posted June 29, 2014 If you suspect gyno I would do LFTs as well. Some OTC "supplements" are highly hepatoxic and can cause gyno. Link to comment Share on other sites More sharing options...
primadonna22274 Posted June 30, 2014 Share Posted June 30, 2014 This is a pretty good review article: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2770912/#!po=27.0492 Before embarking on an expensive and potentially harmful workup, first rule out pseudogynecomastia with a careful physical exam. Pseudogynecomastia is diffuse adipose mimicking breast tissue, usually in an obese male or otherwise with estrogen-testosterone imbalance (advanced liver disease for example). If there is no palpable glandular tissue in the subareolar region by palpation, the appearance of breast tissue is just diffuse adipose. If you're not sure, an US could differentiate subcutaneous fat from glandular tissue. Remember that gynecomastia is frequent in pre-adolescent/young adolescent males--50-60% prevalence! You really wanna work up every one of them? I don't think so. Careful physical exam, reassurance and repeat exam in 6 mos. Overwhelmingly these self-resolve. The article goes into much more detail. Link to comment Share on other sites More sharing options...
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