"Witch's milk" and 99mTc-pertechnetate uptake in neonatal breast tissue: an uncommon but not unexpected finding.

Milk coming from the breast of newborn is called "witch's milk", and it results from transplacental transfer of maternal hormones. We present a case of a 5-day-old female neonate with secretion of "witch's milk", prominent breast nodules, and uptake of 99mTc-perchnetate in bilateral breast nodules on Meckel scan. Familiarity with this uncommon though not unexpected finding is needed to avoid confusion while interpreting Meckel scintigraphy.

Milk flow rates can be used to identify and investigate milk ejection in women expressing breast milk using an electric breast pump.

Currently there is no simple method available to assess milk ejection and breast milk flow in lactating women in both the clinical and research setting. The authors hypothesize that changes in milk flow rate are associated with milk ejection and therefore may provide a method suitable for the assessment of milk ejection and removal. Mothers (n = 23) expressed milk from one breast for a 15-minute period using both weak and strong vacuums on two to four separate occasions using an experimental electric breast pump (Medela AG, Baar, Switzerland). Breast milk flow rates were recorded at 5-second intervals by connecting a tube from the breast shield to a bottle placed on a balance that was connected to a computer. Milk ejection was determined by an acute increase in milk duct diameter in the contralateral breast using ultrasound (Acuson XP10, Siemens, Mountain View, CA), and the change in duct diameter was compared with milk flow rates. Milk flow rates ranged from 0 to 4.6 g per 5-second period. Increases in flow rates were positively associated with increases in duct diameter (p < 0.05). Furthermore, within each milk ejection, higher maximum duct diameters were positively related to greater volumes expressed per 5-second periods (p < 0.001). Time to the first milk ejection and number of milk ejections were the same when determined by ultrasound or flow rates. This direct relationship between increases in duct diameter and acute increases in milk flow rates suggests that changes in flow rates can be used to identify milk ejection in the absence of ultrasound data.

Ultrasound imaging of milk ejection in the breast of lactating women.

OBJECTIVE: Currently, the methods for assessing milk ejection in women include serial sampling of plasma oxytocin and measurement of intraductal pressure, both of which are invasive and may induce stress. We hypothesized that milk ejection would cause an increase in milk-duct diameter that could be observed noninvasively with ultrasound, and this could be used to investigate the physiology of milk ejection in women. METHODS: One milk duct was scanned in the unsuckled breast in 2 groups of mothers: group BB (n = 21) for the beginning of a breastfeed and group EB (n = 24) for the entire breastfeed. A duct also was monitored for a 5-minute period on 2 separate days in the absence of factors that may induce milk ejection in group EB to provide a baseline duct diameter. Milk intake at a breastfeed was measured by test weighing. RESULTS: A significant increase in milk-duct diameter was observed when milk ejection was sensed and/or the infant changed its swallowing pattern in both groups. Multiple increases and decreases (mean: 2.5 per breastfeed; standard deviation: 1.5; n = 62) in duct diameter occurred in group EB. Duct diameter remained relatively stable between breastfeeds (coefficient of variation: 1.4%-8.3%). Infant milk intake was positively related to the number of milk ejections (r2 =.365; n = 57). CONCLUSIONS: Ultrasound is an objective, noninvasive technique for detecting milk ejection by observing an increase in milk-duct diameter. However, this technique requires an experienced ultrasonographer, adequate imaging time, and surroundings conducive to breastfeeding. Multiple milk ejections were common during breastfeeding, although they were not sensed by mothers. The number of milk ejections influenced the amount of milk the infant consumed.

The ultrasound appearances of galactocoeles.

Galactocoeles are an uncommon cause of breast masses, usually occurring in lactating women. The purpose of this study was to review the ultrasound (US) features of galactocoeles presenting to the Nottingham Breast Unit. Eight women with galactocoeles were scanned during 1994 and 1995. All the scans were abnormal, 50% of lesions were cystic or multicystic, 37% mixed cystic/solid and 13% appeared solid. A fat-fluid level was seen in only one case. Two of the cystic/solid lesions had ill defined solid components, raising the possibility of an intracystic carcinoma. All cases were confirmed by the aspiration of milk and clinical resolution following aspiration.