Pulsating Sensation Under Right Breast Fold Near Sternal Border

Diagnostic Approach

The American Heart Association suggests that a pulsating sensation under the right breast fold near the sternal border is most likely a normal finding representing visualization or palpation of the abdominal aorta or internal mammary artery pulsations, though a mammary souffle should be considered if a continuous murmur is auscultated over the area 1, 2
The American College of Cardiology recommends determining if the pulsation is visible, palpable, or audible to differentiate between normal vascular pulsations and potential pathology 2
A palpable cord-like structure with pain may indicate Mondor disease, a thrombosed thoracoepigastric vein, according to the American College of Phlebology 3, 4

The American College of Radiology suggests that normal arterial pulsations from the abdominal aorta or internal mammary artery branches can cause a benign pulsating sensation 2
Mammary souffle, a benign vascular murmur, can be diagnosed by compression maneuver, which resolves the murmur, as recommended by the American Heart Association 1, 2
Pre-eruptive herpes zoster can present with severe dermatomal pain before rash appearance, and immediate antiviral therapy is warranted, according to the Infectious Diseases Society of America 3

The American College of Physicians recommends performing a focused physical examination, including auscultation for murmur and compression maneuver, to diagnose mammary souffle 1, 2
If focal pain is present without a clear benign cause, age-appropriate imaging should be ordered, such as ultrasound alone for women under 30 years or mammography with ultrasound for women 30 years and older, as suggested by the American College of Radiology 3, 4
The American Academy of Family Physicians advises against dismissing focal, unilateral breast pain without proper evaluation, as some cancers can present with pain alone 4, 6