Amanda D. Ingram, MD, Mary C. Mahoney, MD

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Presentation transcript:

An Overview of Breast Emergencies and Guide to Management by Interventional Radiologists Amanda D. Ingram, MD, Mary C. Mahoney, MD Techniques in Vascular & Interventional Radiology Volume 17, Issue 1, Pages 55-63 (March 2014) DOI: 10.1053/j.tvir.2013.12.009 Copyright © 2014 Elsevier Inc. Terms and Conditions

Figure 1 Ultrasound image of a hypoechoic abscess with layering mobile debris in the right breast. Techniques in Vascular & Interventional Radiology 2014 17, 55-63DOI: (10.1053/j.tvir.2013.12.009) Copyright © 2014 Elsevier Inc. Terms and Conditions

Figure 2 A 15-G peel-away sheath and needle. (Color version of figure is available online.) Techniques in Vascular & Interventional Radiology 2014 17, 55-63DOI: (10.1053/j.tvir.2013.12.009) Copyright © 2014 Elsevier Inc. Terms and Conditions

Figure 3 The needle and sheath are advanced into the collection with ultrasound guidance. Techniques in Vascular & Interventional Radiology 2014 17, 55-63DOI: (10.1053/j.tvir.2013.12.009) Copyright © 2014 Elsevier Inc. Terms and Conditions

Figure 4 Close-up image of a trocar through the catheter. (Color version of figure is available online.) Techniques in Vascular & Interventional Radiology 2014 17, 55-63DOI: (10.1053/j.tvir.2013.12.009) Copyright © 2014 Elsevier Inc. Terms and Conditions

Figure 5 The needle is removed and a 5-F pigtail catheter is advanced through the sheath. (Color version of figure is available online.) Techniques in Vascular & Interventional Radiology 2014 17, 55-63DOI: (10.1053/j.tvir.2013.12.009) Copyright © 2014 Elsevier Inc. Terms and Conditions

Figure 6 The tip of the 5-F catheter is seen advancing through the needle inside the abscess. Techniques in Vascular & Interventional Radiology 2014 17, 55-63DOI: (10.1053/j.tvir.2013.12.009) Copyright © 2014 Elsevier Inc. Terms and Conditions

Figure 7 The catheter is seen exiting the tip of the peel-away sheath after removing the needle. (Color version of figure is available online.) Techniques in Vascular & Interventional Radiology 2014 17, 55-63DOI: (10.1053/j.tvir.2013.12.009) Copyright © 2014 Elsevier Inc. Terms and Conditions

Figure 8 The pigtail catheter is fully deployed in the abscess. Once adequate positioning is confirmed, the peel-away sheath is removed. Techniques in Vascular & Interventional Radiology 2014 17, 55-63DOI: (10.1053/j.tvir.2013.12.009) Copyright © 2014 Elsevier Inc. Terms and Conditions

Figure 9 Pigtail catheter is shown through the peel-away sheath. (Color version of figure is available online.) Techniques in Vascular & Interventional Radiology 2014 17, 55-63DOI: (10.1053/j.tvir.2013.12.009) Copyright © 2014 Elsevier Inc. Terms and Conditions

Figure 10 Peel-away sheath is removed, leaving the pigtail catheter in place. (Color version of figure is available online.) Techniques in Vascular & Interventional Radiology 2014 17, 55-63DOI: (10.1053/j.tvir.2013.12.009) Copyright © 2014 Elsevier Inc. Terms and Conditions

Figure 11 The abscess collection decreases in size as the purulent fluid is aspirated. Techniques in Vascular & Interventional Radiology 2014 17, 55-63DOI: (10.1053/j.tvir.2013.12.009) Copyright © 2014 Elsevier Inc. Terms and Conditions

Figure 12 The abscess is irrigated with saline. Techniques in Vascular & Interventional Radiology 2014 17, 55-63DOI: (10.1053/j.tvir.2013.12.009) Copyright © 2014 Elsevier Inc. Terms and Conditions

Figure 13 Postbiopsy hemorrhage has led to significant asymmetric enlargement of the left breast and bruising extending over the left breast and down the side and flank. (Color version of figure is available online.) Techniques in Vascular & Interventional Radiology 2014 17, 55-63DOI: (10.1053/j.tvir.2013.12.009) Copyright © 2014 Elsevier Inc. Terms and Conditions

Figure 14 Large left breast hematoma from a seat belt injury with a blush of contrast indicating active extravasation. (Color version of figure is available online.) Techniques in Vascular & Interventional Radiology 2014 17, 55-63DOI: (10.1053/j.tvir.2013.12.009) Copyright © 2014 Elsevier Inc. Terms and Conditions

Figure 15 A hypoechoic pseudoaneurysm with an echogenic rim in the left axilla. Techniques in Vascular & Interventional Radiology 2014 17, 55-63DOI: (10.1053/j.tvir.2013.12.009) Copyright © 2014 Elsevier Inc. Terms and Conditions

Figure 16 Color flow Doppler imaging demonstrates the swirling “ying-yang” appearance characteristic of a pseudoaneurysm. (Color version of figure is available online.) Techniques in Vascular & Interventional Radiology 2014 17, 55-63DOI: (10.1053/j.tvir.2013.12.009) Copyright © 2014 Elsevier Inc. Terms and Conditions

Figure 17 Power Doppler imaging clearly demonstrates the feeding artery. This vessel should be identified before treatment. (Color version of figure is available online.) Techniques in Vascular & Interventional Radiology 2014 17, 55-63DOI: (10.1053/j.tvir.2013.12.009) Copyright © 2014 Elsevier Inc. Terms and Conditions

Figure 18 A 25-G needle is advanced into the pseudoaneurysm with ultrasound guidance. (Color version of figure is available online.) Techniques in Vascular & Interventional Radiology 2014 17, 55-63DOI: (10.1053/j.tvir.2013.12.009) Copyright © 2014 Elsevier Inc. Terms and Conditions

Figure 19 Thrombin is slowly injected into the pseudoaneurysm under ultrasound visualization until internal flow ceases. (Color version of figure is available online.) Techniques in Vascular & Interventional Radiology 2014 17, 55-63DOI: (10.1053/j.tvir.2013.12.009) Copyright © 2014 Elsevier Inc. Terms and Conditions