Breast pseudoaneurysm after core needle biopsy in a pregnant patient

Abstract

Breast pseudoaneurysm is an extremely rare complication of interventional breast procedures. Pregnancy and lactation are associated with increased breast vascularization, which may act as a risk factor. We present the case of a 36-year-old woman in the third trimester of a spontaneous twin pregnancy, who presented with a newly-detected BI-RADS 4 mass in her right breast. The patient requested not to defer a biopsy until after the pregnancy, and an ultrasound-guided breast core biopsy was performed. The patient presented bleeding during the procedure, but no hematomas or other vascular lesions were immediately detected. During follow-up, a breast ultrasound revealed an anechoic circumscribed mass and high‐velocity blood flow. The color Doppler showed a spiral blood flow with the Yin-Yang sign, together with a communication channel between the sac and feeding artery. A diagnosis of breast pseudoaneurysm was made. The patient was managed conservatively, and breastfeeding continued normally. This case report highlights the importance of color Doppler in the detection of pseudoaneurysms, and the need to consider deferring invasive breast procedures in pregnant women when possible.

Breast pseudoaneurysm: two case reports

“…Its incidence is 0.05%-0.5%. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] PSA is produced by a local trauma generating transmural disruption of the vascular wall and the arterial pressure of the blood cuts up the adjacent tissues, creating a sac that communicates with the lumen of the vessel. This sac is surrounded by 2 layers, the media, and the adventitia.…”

“…PSA can measure 1cm to 3cm and connects with the artery that originates it. 3,4,6,9,12,15,16,17,18,20 After 3 weeks, PSA is heterogeneous mass with an anechoic center and hyperechogenic ring. Three months later, PSA appears with echogenic material inside the nodule and with absent of vascularity using color Doppler due to spontaneous thrombosis.…”

“…1,4,7,9, 10 ,12,17,18,20 Color Doppler has a diagnostic certainty of 95% for PSA. 9,10,16 PSA, attributable to its pulsatile nature, maintains a bidirectional arterial flow through the vascular sac; During the high intraarterial pressure of systole, the blood flow is anterograde towards the pseudoaneurysm and during the diastole the flow direction is retrograde, causing a turbulent or swirling flow in the non-thrombosed portion of PSA, forming the typical Yin-Yang sign. [1][2][3][4]6,9,10,12,[14][15][16][17][18][19][20] In angiotomography, PSA appears as a hypodense saccular mass, with a soft tissue wall, that is communicated to the artery that origins it.…”

“…The spontaneous thrombosis is associated to the size of the PSA, the diameter of the neck, and the anticoagulant status of the patient. 9,11,19,20 The size of PSA neck is fundamental to know if the patient will benefit from percutaneous treatment. If the neck is narrow, management with compression or prothrombin percutaneous injection may be considered.…”

Pseudoaneurysm after an ultrasound-guided breast core needle biopsy in a lactating woman

“…Breast vascularity is substantially increased during pregnancy and lactation. Local procedures should, therefore, be carefully considered, and deferring them until after the breastfeeding period is often the most appropriate choice [1].…”