The feasibility of ultrasound-guided vacuum-assisted evacuation of large breast hematomas

Abstract

Background Breast hematoma is an often underrated and disregarded post-procedural complication in the literature. Current treatment modalities are comprised of either surgical or expectant therapy, while percutaneous procedures play a smaller role in their treatment. We aimed to examine the efficacy of vacuum-assisted evacuation (VAE) in the treatment of clinically significant large breast hematomas as an alternative to surgery. Patients and methods We retrospectively analysed patients that underwent breast interventions (surgical and percutaneous), who later developed clinically significant large hematomas and underwent a trial of VAE of hematoma in our hospital within the period of four years. Patient and procedure characteristics were acquired before and after VAE. Success of intervention was based on ≥ 50% clearance of hematoma volume and patients' subjective resolution of symptoms. All patients were followed clinically and by ultrasound if needed at different intervals depending on the severity of presenting symptoms. Results Eleven patients were included in the study. The mean largest diameter of hematomas was 7.9 cm and mean surface area was 32.4 cm2. The mean duration of the procedure was 40.5 min. In all patients VAE of hematoma was implemented successfully with no complications. Control visits showed no major residual hematoma or seroma formation. Conclusions Our results show that VAE of hematoma can be implemented as a safe alternative to surgery in large, clinically significant hematomas, regardless of aetiology or duration. The procedure carries less risk, stress and cost with the added benefit of outpatient treatment when compared to surgical treatment.

Keywords: breast; breast hematoma; hematoma evacuation; vacuum assisted breast biopsy.

Figures

Figure 1

Illustration of a vacuum assisted evacuation of hematoma in patient number 9. Vacuum assisted excision of a discordant lesion (A) at core biopsy resulted in a palpable painful hematoma. Ultrasound image of the 5.5x4.0 cm hematoma (B). Complete evacuation of the hematoma with sparing of hematoma wall (C); Large arrows indicate needle’s shaft and small white arrows indicate hematoma wall

Figure 2

Patient number 10 with massive two-sided communicating hematoma treated through separate punctures. Image (A) represents a panoramic view of the cranial aspect of the 12 cm long hematoma and image (B) represents a panoramic view after the evacuation. Image (C) represents the caudal 20 cm long hematoma and correspondingly image (D) shows the view after treatment.