E1796. Pseudoaneurysm After Core Breast Biopsy: A Pictorial Illustration of Presentation and Management
  1. David Wessling; University of Nebraska Medical Center
  2. Lei Yu; University of Nebraska Medical Center
  3. Ehab Saad Aldin; University of Nebraska Medical Center
Pseudoaneurysm is a very rare but serious complication of imaged guided breast core biopsy. Patients often present days after the biopsy with bruising and enlarging hematoma. Ultrasound is the best imaging modality for diagnosis with typical “to and fro” or “yin-yang” appearance. Treatment options include external compression, ultrasound-guided thrombin injection, percutaneous or endovascular embolization, and open surgical repair.

Educational Goals / Teaching Points
This exhibit will review the clinical presentation and imaging characteristics of pseudoaneurysm after breast core biopsy and different management options including interventional treatments through case discussions. We will also review normal breast arterial anatomy and techniques of breast core needle biopsy procedures.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Two patients with pseudoaneurysms after core needle biopsy of the breast were treated at our department between January 2019 and December 2021 (one stereotactic-guided biopsy and one ultrasound-guided biopsy). Both patients presented with enlarging hematoma after the biopsy. Ultrasound demonstrated typical “to and fro” pattern. Patients were subsequently referred to intervention radiology for urgent embolization of pseudoaneurysm. One patient had a large pseudoaneurysm (3 cm by 1.8 cm) on ultrasound. Angiogram was performed through direct stick into the pseudoaneurysm and showed that the pseudoaneurysm originated from a large branch of the right internal mammary artery. Embolization was performed with a combination of percutaneous embolization and ultrasound-guided thrombin injection. The other patient had a small pseudoaneurysm with visible neck and was treated with US guided thrombin injection.

Pseudoaneurysm after core breast biopsy is a very rare complication. Prompt identification and intervention are key to avoid serious outcome. Viewers will be familiar with the typical clinical presentation, imaging characteristics, and different treatment options after reviewing this exhibit.