March 27, 2009

Breast Hematoma

Fig. 1&2: Ultrasound of the right breast of a 79-year-old woman with a lump shows a mass with a fluid-fluid level (between arrows). The more dependent 'debris' appears to be more echogenic than the non-dependent fluid. There is no color flow within the mass.
Fig. 3: CT scan without IV contrast showed a large mass, again with a fluid-fluid level. The denser portion of the mass measured 60 HU, consistent with blood clot. The scan also revealed a markedly enlarged left atrium. The patient is on anticoagulant therapy for chronic atrial fibrillation.

  • Common causes: post procedure (biopsy, surgery), direct trauma, coagulopathy
  • Breast hematoma occurs in approximately 2% - 10% after breast surgery
  • Risk factors: use of some medications (aspirin, NSAIDs, anticogulants)
US Findings:
  • Depends on stage of blood product
  • Clotted blood appears echogenic, lysed blood (serum) appears cystic.
  • No internal flow

Our case - follow up ultrasound was performed and the mass has evolved into a lysed hematoma and then disappeared. Diagnosis was breast hematoma related to anticoagulant use.

Vitug AF, Newman LA. Complications in breast surgery. Surg Clin N Am 2007;87:431-451.

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