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Pseudoaneurysm of the breast: the use of color Doppler sonography.

Pseudoaneurysm of the Breast: The Use of Color Doppler Sonography We read with interest the excellent paper “Percutaneous Repair of Breast Pseudoaneurysm: Sonographically Guided Embolization” I I J. We report a case of breast pseudoaneurysm in which the patient presented with a new palpable mass without iatrogenic trauma and in which color Doppler sonography was essential to making the diagnosis. A 47-year-old woman with a history of controlled hypertension was referred to our clinic for a new palpable mass in the breast at the 12-o’clock position. The mass was well marginated on mammography (Fig. 1A) and solid on gray-scale sonography (Fig. I B). No flow was evident on real-time sonography. In our clinic, color Doppler imaging is available on our sonography machines, and we routinely look briefly at the vascularity of a mass. To our surprise, in this instance the solid mass was entirely vascular and had the characteristic mixed arterial and venous signals of a pseudoaneunysm (Fig. IC). When asked, the patient denied a history of trauma on biopsy to this area. Pseudoaneurysm of the breast is uncommon and has been reported in association with hypertension and anticoagulation therapy and after lumpectomy [21. Several recent reports have documented its occurrence with 14gauge needle core biopsy of the breast [I . 31. Close follow-up, surgical repair. and recent embolization have been used to treat the lesion. To our knowledge, successful compression-ablation therapy has not been reported. With the advent of many minimally invasive surgical techniques now available to radiologists, we recognize the trend to make the diagnosis in some indeterminate cases rather than to watch and wait L4]. This fact is particularly true in mammography. wherein some masses can be successfully biopsied with 18and 20-gauge cone needles and a definitive pathologic diagnosis obtained. The newer cone biopsy devices used with steneotactic guidance can completely remove clusters of microcalcifications rather than simply sample them. In this case, were it not for the judicious application of color Doppler sonognaphy, we might have performed a sonognaphically guided core biopsy and perhaps put the patient at risk for significant bleeding as a result.