TABLE 16.4 IMPORTANT HISTORICAL AND PHYSICAL EXAMINATION COMPONENTS IN THE EVALUATION OF A BREAST LESION History Onset and duration of lesion Pain Nipple discharge Relationship of lesion with menses Complete menstrual and sexual development history, including sexual activity and previous pregnancies Family history of breast disease Diet Medications and illicit drugs Concomitant medical disorders Systemic symptoms: fever, weight loss, sweating, headaches, visual changes Physical Examination Breasts: symmetry, skin appearance, temperature, areola, nipples, secretions, masses, chest wall, axillae Lymph nodes Hair distribution Genitalia Diagnostic Testing The majority of patients presenting to the ED will not require intensive laboratory or radiologic testing All postmenarchal girls should have a pregnancy test performed; breast tenderness and swelling are among the earliest signs of pregnancy The most helpful test in the emergency setting is breast ultrasonography, which is useful in distinguishing between masses and cystic lesions as well as the presence of abscess with mastitis Other imaging studies are rarely helpful Mammography is of little value in children and adolescents, owing to the high proportion of fibroglandular tissue within the breast Chest radiography is rarely helpful, except when the examiner elicits signs and symptoms from the lungs or chest wall that may be referred to the breast If