Urgent and emergent breast lesions – A primer for the general radiologist, on‐call resident and sonographer

Abstract

There are very few true breast emergencies. While infrequent, women do present to emergency departments or urgent care centres with breast‐related concerns. In this case‐based review, both common and uncommon urgent and emergent breast lesions are presented, emphasising ultrasound characteristics and imaging optimisation to improve accurate diagnosis and appropriate recommendations.

Breast pseudoaneurysm: two case reports

“…Its incidence is 0.05%-0.5%. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] PSA is produced by a local trauma generating transmural disruption of the vascular wall and the arterial pressure of the blood cuts up the adjacent tissues, creating a sac that communicates with the lumen of the vessel. This sac is surrounded by 2 layers, the media, and the adventitia.…”

“…PSA can measure 1cm to 3cm and connects with the artery that originates it. 3,4,6,9,12,15,16,17,18,20 After 3 weeks, PSA is heterogeneous mass with an anechoic center and hyperechogenic ring. Three months later, PSA appears with echogenic material inside the nodule and with absent of vascularity using color Doppler due to spontaneous thrombosis.…”

“…9,10,16 PSA, attributable to its pulsatile nature, maintains a bidirectional arterial flow through the vascular sac; During the high intraarterial pressure of systole, the blood flow is anterograde towards the pseudoaneurysm and during the diastole the flow direction is retrograde, causing a turbulent or swirling flow in the non-thrombosed portion of PSA, forming the typical Yin-Yang sign. [1][2][3][4]6,9,10,12,[14][15][16][17][18][19][20] In angiotomography, PSA appears as a hypodense saccular mass, with a soft tissue wall, that is communicated to the artery that origins it. The PSA is associated with central enhancement.…”

Diversity in ultrasound practice and education

“…While reviewing this edition of the journal, I began reflecting on the diversity of ultrasound delivery. In this AJUM issue, we have a unique and rare furcate umbilical cord insertion diagnosis, 1 a primer on emergency breast lesions, 2 a systematic review investigating the role of ultrasound in surgical patients in low and middle income countries, 3 and two articles about teaching non‐experts to undertake ultrasound, including to guide knee procedures 4 and to diagnose bone fractures 5 . I can remember a time when the education was largely informal and at the bedside – the so‐called ‘see one, do one’ approach.…”

“…Initially ultrasound was used to identify anatomy, later function and blood flow, and now we find ourselves able to characterise tissue. In this AJUM edition, there is an excellent review article from colleagues at the Mayo Clinic, 2 in which they describe the ultrasound appearances and characteristics of breast lesions presenting in emergency or urgent care facilities. Not only is ultrasound being used to diagnose these breast lesions but also ultrasound is an important part of the emergency care triage pathway.…”