Cardiac injury during needle localized surgical breast biopsy

Abstract

Needle localized breast biopsy is commonly used to diagnose and remove non-palpable breast lesions. We present the first case of cardiac injury resulting from needle localized breast biopsy. A hooked-end monofilament wire penetrated the pericardium and myocardium overlying the left ventricle. The wire was pulled and the patient managed non-operatively with close monitoring that included plain chest radiographs, electrocardiography, and echocardiography. The literature regarding complications of the procedure was reviewed.

Presurgical Localization of Breast Abnormalities: An Overview and Analysis of 202 Cases

“…Of the known complications the most common ones are vasovagal reactions and bleeding both of which are self limited and easy to manage and almost never lead to cancellation or failure of the procedure. Migration of the wire, fragmentation of the wire, and pneumothorax, are very rare complications [9,10]. There has been a report of a hook wire causing delayed cardiac injury by penetrating the pericardium and myocardium and lodging in the aorta with patient presenting with chest pain.…”

“…Following an echocardiogram and CT scan the wire was surgically removed. [9] We did not encounter any procedure related complications during the one year study period, Specimen radiography following imaging guided localization is performed for several reasons. Primarily it verifies that the entire lesion has been removed.…”

Ultrasound and Mammography Guided Wire Marking of Non-Palpable Breast Lesions: Analysis of 741 Cases

“…This approach is capable of reducing the error rate. Complications other than wire migration into the pectoral muscle and broken wire tips (reported by us) include wire migration into the axilla [38], the neck [39], the chest wall (potentially leading to pneumothorax) [40], the gluteal area [36], the abdomen [41], and even migration into the hilum [42] and the heart [43].…”

Migration of a breast guidewire into the pleural cavity

“…If the open hook of the guidewire reaches into the pectoralis muscle, repeated contractions may 'drive' the wire through the intercostal space and into the pleural cavity. 2,[5][6][7] For lesions located deep within the breast where this may be a concern, the pectoralis muscle can be avoided by inserting the guidewire parallel to the chest wall. 7,8 Risk of wire migration also likely increases with the length of the subcutaneous tract.…”

“…2,[5][6][7] For lesions located deep within the breast where this may be a concern, the pectoralis muscle can be avoided by inserting the guidewire parallel to the chest wall. 7,8 Risk of wire migration also likely increases with the length of the subcutaneous tract. Therefore, the shortest and most direct route from the skin to the target should be preferred, allowing for other technical considerations.…”