Trauma and Surgical Critical Care Division, Department of Surgery, Faculty of Medicine, Thammasat University, 99/209 M.18, Klonglaung, Pathumthani, Thailand.
Head-Neck-Breast Surgery Division, Department of Surgery, Faculty of Medicine, Thammasat University, Pathumthani, Thailand.
J Med Case Rep. 2024 Sep 7;18(1):435. doi: 10.1186/s13256-024-04731-9.
Complications after percutaneous breast biopsy are infrequent but may include hematoma, pseudoaneurysm formation, persistent pain, infection, delayed wound healing, vasovagal reaction, hemothorax, pneumothorax, and neoplastic seeding. The risk factors include tumor factors (size, location, vascularity), procedure-related factors (needle diameter, number of biopsies), and interventionist experience. There has been no previous report of a fatal complication resulting from percutaneous breast biopsy.
We report a 54-year-old Asian woman with a 3 cm BI-RADS 4B left breast mass in the lower-inner quadrant who was biopsied by a 16 G needle under ultrasound guidance at a province hospital. She experienced dizziness and near-syncope afterward. The initial evaluation showed evidence of cardiac tamponade with hemodynamic instability. She underwent urgent subxiphoid pericardial window and was transferred to our facility. We brought her directly to the operating room to perform an explorative median sternotomy and found a 0.2 cm hole in the right ventricle. The injured site was successfully repaired without cardiopulmonary bypass. Postoperative echocardiography demonstrated mild right ventricular dysfunction without evidence of septal or valvular injury. She survived with no significant complications.
This case might be the first report of a life-threatening complication related to percutaneous breast core-needle biopsy. The rapid pericardial release is key to the survival of cardiac tamponade. The patient subsequently required cardiac repair and monitoring to avoid long-term complications. In this report, we suggested a safe biopsy method, complications recognition, and appropriate management of penetrating cardiac injury.
Penetrating cardiac injury resulting from percutaneous breast biopsy is extremely rare but can occur. A biopsy must be done cautiously, and worst-case management should promptly be considered.
经皮乳腺活检后发生并发症的情况并不常见，但可能包括血肿、假性动脉瘤形成、持续性疼痛、感染、伤口愈合延迟、血管迷走神经反应、血胸、气胸和肿瘤种植。危险因素包括肿瘤因素（大小、位置、血管性）、与操作相关的因素（针的直径、活检次数）和介入医生的经验。以前没有经皮乳腺活检导致致命并发症的报告。
我们报告了一名 54 岁亚洲女性，左乳房下内象限有一个 3 厘米 BI-RADS 4B 大小的肿块，在省医院行超声引导下 16G 针活检。她之后出现头晕和近乎晕厥。最初的评估显示有心包填塞的证据，伴有血流动力学不稳定。她紧急进行了剑突下心包开窗术，并转至我院。我们直接将她送到手术室进行探查性正中胸骨切开术，发现右心室有一个 0.2 厘米的孔。受伤部位在无体外循环的情况下成功修复。术后超声心动图显示右心室功能轻度障碍，无间隔或瓣膜损伤的证据。她存活下来，没有出现明显的并发症。
这可能是首例与经皮乳腺芯针活检相关的危及生命的并发症报告。快速的心包释放是抢救心脏压塞的关键。患者随后需要心脏修复和监测，以避免长期并发症。在本报告中，我们提出了一种安全的活检方法、并发症识别以及穿透性心脏损伤的适当处理方法。
经皮乳腺活检导致的穿透性心脏损伤极为罕见，但确实可能发生。活检必须谨慎进行，应迅速考虑最坏情况的处理。
