A 56-year-old man presented with a painless lump in the left breast that had been growing for approximately 2 years. The patient also had bloody nipple discharge for the last 2 years. There were no other relevant features in the history, which included diabetes mellitus.Physical examination revealed a 3 cm soft mobile lump in the left breast and a palpable left axillary lymph node. Conventional low-dose mammography was performed initially, which demonstrated a well-circumscribed mass of intermediate density, posterior to the nipple. There were no calcifications (Fig. 1). In order to determine the solid or cystic nature of the lesion, an ultrasound study was performed. Using a 7.5 MHz probe, it showed a 27 mm × 22 mm lesion, predominately cystic, but an irregular soft tissue mass (13 mm × 12 mm) projected from the wall into the lumen (Fig. 2). Color and power Doppler revealed minimal vascularity in the mass. The axillary lymph node was of a reactive type and presented intensive vascularity of the hilus.On aspiration, bloody fluid was obtained and cytologic examination showed cellular atypia. Excisional surgery Figure 1. Low-dose mammography. Mediolateral oblique and craniocaudal views show a wellcircumscribed mass of intermediate density posterior to the nipple.
Major vascular injuries during laparoscopic cholecystectomy are rare, usually readily apparent, and immediately treated. We report a case of delayed presentation of a retroperitoneal vascular injury. The patient presented with abdominal pain and increasing edema of the lower extremities 1 year after laparoscopic cholecystectomy and was found to have an ilio-iliac arteriovenous fistula. Endovascular treatment was accomplished using a graft-covered polytetrafluoroethylene stent. The patient remained free of symptoms at 1-year follow-up.
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