<abstract xmlns="http://www.w3.org/1999/xhtml"><sec id="j_raon-2020-0041_s_005_w2aab3b7c23b1b6b1aab1c16b1Aa"><h3>Background</h3><p>Breast hematoma is an often underrated and disregarded post-procedural complication in the literature. Current treatment modalities are comprised of either surgical or expectant therapy, while percutaneous procedures play a smaller role in their treatment. We aimed to examine the efficacy of vacuum-assisted evacuation (VAE) in the treatment of clinically significant large breast hematomas as an alternative to surgery.</p></sec><sec id="j_raon-2020-0041_s_006_w2aab3b7c23b1b6b1aab1c16b2Aa"><h3>Patients and methods</h3><p>We retrospectively analysed patients that underwent breast interventions (surgical and percutaneous), who later developed clinically significant large hematomas and underwent a trial of VAE of hematoma in our hospital within the period of four years. Patient and procedure characteristics were acquired before and after VAE. Success of intervention was based on ≥ 50% clearance of hematoma volume and patients’ subjective resolution of symptoms. All patients were followed clinically and by ultrasound if needed at different intervals depending on the severity of presenting symptoms.</p></sec><sec id="j_raon-2020-0041_s_007_w2aab3b7c23b1b6b1aab1c16b3Aa"><h3>Results</h3><p>Eleven patients were included in the study. The mean largest diameter of hematomas was 7.9 cm and mean surface area was 32.4 cm<sup>2</sup>. The mean duration of the procedure was 40.5 min. In all patients VAE of hematoma was implemented successfully with no complications. Control visits showed no major residual hematoma or seroma formation.</p></sec><sec id="j_raon-2020-0041_s_008_w2aab3b7c23b1b6b1aab1c16b4Aa"><h3>Conclusions</h3><p>Our results show that VAE of hematoma can be implemented as a safe alternative to surgery in large, clinically significant hematomas, regardless of aetiology or duration. The procedure carries less risk, stress and cost with the added benefit of outpatient treatment when compared to surgical treatment.</p></sec></abstract>

BackgroundBreast hematoma is an often underrated and disregarded post-procedural complication in the literature. Current treatment modalities are comprised of either surgical or expectant therapy, while percutaneous procedures play a smaller role in their treatment. We aimed to examine the efficacy of vacuum-assisted evacuation (VAE) in the treatment of clinically significant large breast hematomas as an alternative to surgery.Patients and methodsWe retrospectively analysed patients that underwent breast interventions (surgical and percutaneous), who later developed clinically significant large hematomas and underwent a trial of VAE of hematoma in our hospital within the period of four years. Patient and procedure characteristics were acquired before and after VAE. Success of intervention was based on ≥ 50% clearance of hematoma volume and patients’ subjective resolution of symptoms. All patients were followed clinically and by ultrasound if needed at different intervals depending on the severity of presenting symptoms.ResultsEleven patients were included in the study. The mean largest diameter of hematomas was 7.9 cm and mean surface area was 32.4 cm2. The mean duration of the procedure was 40.5 min. In all patients VAE of hematoma was implemented successfully with no complications. Control visits showed no major residual hematoma or seroma formation.ConclusionsOur results show that VAE of hematoma can be implemented as a safe alternative to surgery in large, clinically significant hematomas, regardless of aetiology or duration. The procedure carries less risk, stress and cost with the added benefit of outpatient treatment when compared to surgical treatment.

The feasibility of ultrasound-guided vacuum-assisted evacuation of large breast hematomas

Radiology and Oncology

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

BackgroundBreast hematoma is an often underrated and disregarded post-procedural complication in the literature. Current treatment modalities are comprised of...

Patient	Size pre-VAE (in cm)	Estimated decrease in size post-VAE (percentage)	Symptoms
1	6 x 4	> 50%	Resolution
2	8 x 4	> 50%	Resolution
3	6 x 3	100%	Resolution
4	6 x 5	100%	Resolution
5	5.5 x 3	100%	Resolution
6	7 x 6.5	80%	Resolution
7	12 x 2.5	70%	Resolution
8	5.5 x 3.5	90%	Resolution
9	5.5 x 4	100%	Resolution
10	20 x 5	80%	Resolution
11	5.5 x 5	100%	Resolution

Patient	Age (yrs)	Wait time Wait time = number of days between surgical intervention/biopsy and VAE of hematoma; (days)	Intervention	Medications	Size (cm)
1	42	14	BLES	Anti-Coagulant	6 x 4
2	67	1	VABB	None	8 x 4
3	38	36	Surgery	None	6 x 3
4	48	78	Surgery	None	6 x 5
5	49	21	Surgery	None	5.5 x 3
6	51	34	Surgery	Anti-hydrocortisone Platelet and	7 x 6.5
7	84	15	Surgery	Anti-Platelet	12 x 2.5
8	71	597	Surgery	None	5.5 x 3.5
9	85	51	VABE	Anti-Coagulant	5.5 x 4
10	60	29	Surgery	None	20 x 5
11	53	22	Surgery	None	5.5 x 5

The feasibility of ultrasound-guided vacuum-assisted evacuation of large breast hematomas

Article Category: Research Article

Published Online: Jun 26, 2020

Page range: 311 - 316

Received: May 03, 2020

Accepted: May 27, 2020

DOI: https://doi.org/10.2478/raon-2020-0041

© 2020 Sa’ed Almasarweh, Mazen Sudah, Sarianna Joukainen, Hidemi Okuma, Ritva Vanninen, Amro Masarwah, published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Figure 1

Figure 2

Hematoma characteristics pre- and post-vacuum assisted evacuation (VAE)

Characteristics of patients with hematoma