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  • The Internet Journal of Surgery
  • Volume 30
  • Number 4

Case Study

Surgical Treatment of Pseudoaneurysm of the Breast

J H McClenathan

Citation

J H McClenathan. Surgical Treatment of Pseudoaneurysm of the Breast. The Internet Journal of Surgery. 2013 Volume 30 Number 4.

Abstract

Formation of a pseudoaneurysm is occasionally caused by a core biopsy procedure on the breast. Most of these pseudoaneurysms are treated by radiologists and are reported in radiology journals. Herein, we report the surgical management of one of these vascular lesions.

 

Core biopsy with or without radiographic guidance has replaced open biopsy for most breast lesions. This technique accurately establishes the diagnosis in most patients and is usually accomplished without complication. One complication which has been reported is the formation of a pseudoaneurysm resulting from injury to a vessel during the procedure. In this article, we report the surgical management of a pseudoaneurysm which resulted from a core biopsy of the breast.

Case report

A 57-year-old woman was evaluated for pain in her right breast. She had previously had a lumpectomy and radiotherapy for infiltrating carcinoma several years earlier. Her most recent mammogram showed a well circumscribed and round density in the same breast. Because of concern for recurrent cancer, a 14 gauge core needle biopsy was done. There was significant bleeding after the biopsy which was controlled by compression. Despite the compression, the patient developed a large hematoma around the biopsy site which resolved over the next month.

She later experienced unrelenting pain near her biopsy site and was referred for surgical evaluation. Her examination then was normal. A follow-up Doppler ultrasound, however, revealed a pulsatile pseudoaneurysm near her previous biopsy site (Figure 1 a, b).

Figure 1a
Ultrasound and Doppler color ultrasound showing the pseudoaneurysm in the breast with vascular flow

Figure 1b
Ultrasound and Doppler color ultrasound showing the pseudoaneurysm in the breast with vascular flow

The patient insisted on a surgical approach to remove and treat the pseudoaneurysm. An ultrasound-guided wire-localized biopsy was done. Pathology revealed an 8-mm pseudoaneurysm and an adjacent normal lymph node. Her pain resolved after the biopsy.

Discussion

 Including our own patient, we have identified 19 patients with pseudoaneurysms of the breast during the past 20 years. (Table 1) Most of these have resulted from ultrasound-guided or stereotactic breast core biopsy.   

Table 1

During the past 20 years, the paradigm for evaluating breast lesions has evolved from surgical biopsy to ultrasound-guided or stereotactic core biopsy techniques. Most of these biopsies are performed by radiologists rather than surgeons. While these procedures are usually without complication, bleeding and hematoma formation have been reported and injury to vessels can occasionally lead to formation of a pseudoaneurysm. These pseudoaneurysms may also result from blunt trauma.12,13 Core biopsy results ranged from fibroadenoma to carcinoma and to benign lymph node.

Of the patients who had a pseudoaneurysm form after a core biopsy, at least ten patients had bleeding reported during the procedure.3,4,6,7,10,11,14,15,16 Hematoma formation was also reported in eight patients.1,2,3,8,9,10,14 Formation of a pseudoaneurysm was recognized immediately in a couple of patients, but in others, the diagnosis was not made for weeks to months.

The diagnosis of a pseudoaneurysm was usually made with ultrasound, sometimes supplemented with Doppler color ultrasound. In most patients, initial treatment was attempted by the radiology team. Compression techniques were used in at least seven patients but were successful in only two.1,4,6,7,8,9, 16 In two patients, the aneurysm thrombosed spontaneously.11,13 Percutaneous embolization and coil placement were used twice.3,7  Surgical treatment was used for four patients including our own.4,9,10  Since our patient had a non-palpable lesion, wire-localization was used and a limited surgical procedure removed the lymph node and the aneurysm.

Conclusion

The increasing use of core biopsy for breast lesions will occasionally cause formation of a pseudoaneurysm. Most of these vascular lesions are treated by radiologic intervention. When those techniques fail, or when the patient requests, a surgical approach can be used.

References

1. Smith SM: Breast pseudoaneurysm after core biopsy. Am J Roentgenol; 1996; 167: 817.
2. Wilkes AN, Needleman L, Rosenberg AL: Pseudoaneurysm of the breast. Am J Roentgenol; 1996;167: 625-626.
3. Beres RA, Harrington DG, Wenzel MS: Percutaneous repair of breast pseudoaneurysm: sonographically guided embolization. Am J Roentgenol; 1997; 169: 425-7.
4. Chorny K, Raza S, Bradley FM, Baum JK: Pseudoaneurysm formation in the breast after core needle biopsy. J Ultrasound Med; 1997; 16: 849-51.
5. Schiller VL, Karlen L, Brenner RJ: Pseudoaneurysm of the breast: the use of color Doppler sonography. Am J Roentgenol; 1998; 170: 1112.
6. Bazzocchi M, Francescutti GE, Zuiani C, Del Frate C, Londero V: Breast pseudoaneurysm in a woman after core biopsy: percutaneous treatment with alcohol. Am J Roentgenol; 2002; 179: 696-8.
7. Vavala C: Diagnosis of pseudoaneurysms of the breast by ultrasound. Journal of Diagnostic Medical Sonography; 2002; 18: 174-176.
8. McNamara MP Jr, Boden T: Pseudoaneurysm of the breast related to 18-gauge core biopsy: successful repair using sonographically guided thrombin injection. Am J Roentgenol; 2002; 179: 924-26.
9. Alvarez S, Fendley M, Allam-Ashe C: Sonology diagnosis of pseudoaneurysms following breast biopsies. Journal of Diagnostic Medical Sonography; 2003; 19: 32-35.
10. Dixon AM, Enion DS: Pseudoaneurysm of the breast: case study and review of literature. Br J Radiol; 2004; 77: 694-7.
11. El Khoury M, Mesurolle B, Kao E, Mujoomdar A, Tremblay F: Spontaneous thrombosis of pseudoaneurysm of the breast related to core biopsy. Am J Roentgenol; 2007; 189: W309-11.
12. Al Hadidy AM, Al Najar MS, Farah GR, Tarawneh ES: Pseudoaneurysm of the breast after blunt trauma: successful treatment with ultrasound-guided compression. J Clin Ultrasound; 2008; 36: 440-2.
13. Lee KH, Ko EY, Han BK, Shin JH, Kang SS, Hahn SY: Thrombosed pseudoaneurysm of the breast after blunt trauma. J Ultrasound Med; 2009; 28: 233-8.
14. Sohn YM, Kim MJ, Kim EK, Chung SH, Kwak JY, Moon HJ, Kim SJ: Pseudoaneurysm of the breast during vacuum-assisted removal. J Ultrasound Med; 2009; 28: 967-71.
15. Sasada S, Namoto-Matsubyashi R, Yokoyama G, Takahashi H, Sakai M, Koiki K, Momosaki S, Uesugi N, Fujii T: Case report of pseudoaneurysm caused by core needle biopsy of the breast. Breast Cancer; 2010; 17: 75-8.
16. Jung HK: Pseudoaneurysm of the breast after core needle biopsy: a case report. J Korean Soc Ultrasound Med 2012; 31: 279-282.
17. Bitencourt AG, Cohen MP, Graziano L, Souza JA, Marques EF, Brites MR, Chojniak R: Pseudoaneurysm after ultrasound-guided vacuum-assisted core breast biopsy. Breast J; 2012; 18: 177-8.

Author Information

James H. McClenathan, MD, Associate Professor of Clinical Surgery
University of Arizona Healthcare South Campus
Tucson, AZ, USA
jhmcclenathan@yahoo.com

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