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Case of the Month

October 2010

Patient Data: 51 year old female

Clinical Info: Palpable mass in the left breast in a severely physically handicapped patient with bluish discoloration of the skin

Hypoechoic mass in the left breast with partly anechoic areas.

Transverse image of the same mass with anechoic areas

Color doppler reveals only one small vessel

A hematoma was suspected and a puncture was performed. The mass proved to be a hematoma and nearly all the blood was aspirated. The image shows the needle in the hematoma after aspiration. After the puncture there was no detectable mass or abnormal flow. Because of her handicap a post traumatic hematoma was presumed to have been the cause.

A half year later the patient presented again with a lump in the same breast at the same site. Again a hematoma was found without any flow in the hematoma. Image shows no flow with color doppler

This time however a solid looking mass was identified next to the hematoma

Transverse image of the mass next to the hematoma

The mass was highly vascularized

The mass has multiple vessel poles. At this time a tumor causing the recurrent hematoma was presumed and an ultrasound guided biopsy was performed. The histological diagnosis was suspicious for a micropapillary carcinoma

The patient was operated. The final diagnosis was a recurrent hematoma caused by a malignant micropapillary breast cancer.
In case of a hematoma without a history of trauma, one should be aware of a possible tumor causing the hemorrhage. Although we searched for a mass the first time the patient presented with a hematoma, we were not able to detect one. Her physical condition led us to the wrong presumption that the trauma had not been noticed

For more unusual breast lesions and pitfalls see

Copyright © Dr. T.S.A. Geertsma, Ziekenhuis Gelderse Vallei, Ede, The Netherlands. All rights reserved.

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