2018 Research Forum

Massive right breast hematoma

Presenter: Laura Castro RA Faculty Sponsor: Manish Amin DO

Jason Jerome MD 1 , Manish Amin DO 2 , Phillip Aguiniga-Navarrete 4 , Laura Castro RA 4 , Daniel Delgadillo MD 3 1 Resident Physician R2 2 Program Director, Emergency Medicine; Health Sciences Associate Clinical Professor, David Geffen School of Medicine UCLA

3 Resident Physician R2, Department of Surgery 4 Emergency Medicine Research Assistant Program

INTRODUCTION We present a case of a female with a large breast hematoma resulting from blunt chest trauma displaying significant pan-computed tomography (pan-CT) findings with minimal secondary injuries. Photographic signed consent was obtained from the patient, including IRB approval for the case report. CASE PRESENTATION A 53-year-old restrained obese female driver with a history of hypertension, congestive heart failure, and generalized anxiety disorder was involved in a high-speed motor vehicle accident (45 mph), rear-ended by another vehicle traveling at an unknown speed. Airbags deployed on impact. No loss of consciousness was reported. She was extricated and ambulated by first responders 20-minutes after arrival. Upon arrival, she was awake alert and fully oriented (GCS 15) complaining of severe right breast pain. She was tachycardic (BP: 128/60, HR: 110-120, RR: 18). Her primary survey was intact and her secondary survey was significant for ecchymosis to her right breast. Her right breast was swollen, tense and exquisitely tender (Image 1)

Image 1: lateral view, right breast hematoma

Image 2: MRI shows large hematoma, right breast

No evidence of trauma to her extremities were observed. Given her history of CHF, a judicious initial bolus of 500ccs of normal saline were given. However, her blood pressure subsequently decreased with a recorded low of 99/72, which responded to a 1-liter normal saline bolus. A pan-CT scan demonstrated a 10.5cm x 12.7cm x 18cmbreast hematoma (Image 2). Remarkably, no evidence of concomitant intra-abdominal and intrathoracic bleeding or injuries were reported by radiology interpretation. The trauma surgeon took on surgical management by direct ligation of an artery laceration in the pectoralis major muscle. Pertinent intra-operative findings were; 1500cc of hematoma in the breast consistent with the patient’s class 3 hemorrhage. Three units of PRBC were transfused and an additional 500ccs of normal saline.

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