Imaging Features and Treatment Options for Breast Pseudoaneurysms After Biopsy: A Case‐Based Pictorial Review

Introduction: Vacuum-assisted breast biopsy (VABB) has been evaluated as a minimally invasive, safe, and accurate procedure with low complication risks; the most frequent one is the mild/moderate hematoma, which occurs with a low-frequency rate, and the majority of patients who experienced it can be treated successfully with only manual compression and dressing. Although cases of uncontrollable catastrophic bleeding are exceedingly rare, local breast vessel involvement is a concrete risk, even in patients with no bleeding propensity. Case Presentation: In this article, we aimed to describe a 60 years-old woman who, following VABB, experienced a massive hematoma without external bleeding and was successfully treated with embolization. The woman was called back for a cluster of suspicious microcalcifications identified in the left breast’s upper-outer quadrant; however, following histopathological analysis, the few samples collected were negative. She had a silent past medical history, 100% performance status, and no active pharmacotherapy. Approximately 15–30 min after VABB, the patient complained of weakness, pain, and lipothymia. A physical examination revealed a massive hematoma without external bleeding. Clinical data reported PaO 65/40 mmHg and blood chemistry Hb < 10 g/dL. The emergency team was alerted to stabilize the patient, and after that, the breast hemorrhage was controlled by endovascular embolization. Despite this being a rare occurrence, it is important to draw up and follow an appropriate protocol to ensure proper patient management and early treatment. Discussion: This case illustrates the prompt and accurate management of a rare complication following VABB. Due to the very high number of patients undergoing this particular procedure, we aim to point out the concrete risk of vascular injury; other similar cases are described to support our thesis and provide different clinical manifestations of this rare occurrence.

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“…Open surgery is to be considered a last resource in case of the failure of the other methods [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Vascular Complications following Vacuum-Assisted Breast Biopsy (VABB): A Case Report and Review of the Literature

Pansa¹,

Guzzardi²,

Santocono

et al. 2023

Tomography

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“…However, several reports have demonstrated that treatment options of PA include US-guided focused compression, thrombin or ethanol injection, percutaneous intervention, and open surgical repair. [ 2 , 8 ] More detailed advantages and disadvantages of each treatment option were summarized in Table 1 .…”

Section: Discussionmentioning

confidence: 99%

Breast Pseudoaneurysm in a Woman after Core Biopsy: Intravascular Glue Embolization

Ahn

Kim

Nam

et al. 2022

Journal of Medical Ultrasound

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Core needle biopsy of breast masses is a common procedure for tissue diagnosis of breast lesions. The incidence of complications is low, with pseudoaneurysm (PA) after core biopsy has been described in the literature, and the subsequent need for surgical management. Ultrasonography is the most common modality used for not only diagnosis but also treatment of a PA. Color Doppler images show a heterogeneous echoic lesion with whirling flow inside of the lesion. We describe a patient whose breast PA that developed after core needle biopsy was successfully treated with sonographically-guided intravascular glue embolization.

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“…Color Doppler ultrasound must be employed to confirm the diagnosis. Blood flow is characterized by a typical swirling motion, called the “Yin-Yang sign” [9] , [10] , [11] .…”

Section: Discussionmentioning

confidence: 99%

Breast pseudoaneurysm after core needle biopsy in a pregnant patient

Pesce

Chico

Binder

2021

Radiology Case Reports

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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.

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Imaging Features and Treatment Options for Breast Pseudoaneurysms After Biopsy: A Case‐Based Pictorial Review

Cited by 17 publications

References 24 publications

Vascular Complications following Vacuum-Assisted Breast Biopsy (VABB): A Case Report and Review of the Literature

Vascular Complications following Vacuum-Assisted Breast Biopsy (VABB): A Case Report and Review of the Literature

Breast Pseudoaneurysm in a Woman after Core Biopsy: Intravascular Glue Embolization

Breast pseudoaneurysm after core needle biopsy in a pregnant patient

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