背景:经皮乳腺活检术后并发症很少见,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,血管迷走反应,血胸,气胸,和肿瘤播种。风险因素包括肿瘤因素(大小,location,血管分布),手术相关因素(针头直径,活检数量),和干预主义经验。以前没有关于经皮乳房活检导致致命并发症的报道。
方法:我们报告了一名54岁的亚洲女性,她的下内象限有3cmBI-RADS®4B左侧乳房肿块,她在省级医院的超声引导下用16G针进行了活检。之后她出现头晕和近乎晕厥。初步评估显示心脏填塞伴血流动力学不稳定。她接受了紧急的剑突下心包窗口,并被转移到我们的设施。我们将她直接带到手术室进行探索性正中胸骨切开术,发现右心室有一个0.2厘米的洞。在没有体外循环的情况下成功修复了受伤的部位。术后超声心动图显示轻度右心室功能障碍,无间隔或瓣膜损伤的证据。她幸存下来,没有明显的并发症。
结论:该病例可能是首例与经皮乳腺穿刺活检相关的危及生命的并发症。心包的快速释放是心脏压塞存活的关键。患者随后需要心脏修复和监测以避免长期并发症。在这份报告中,我们建议一种安全的活检方法,并发症识别,以及心脏穿透性损伤的适当处理。
结论:经皮乳腺活检导致的心脏穿透性损伤极为罕见,但可能发生。活检必须谨慎,最坏情况的管理应该及时考虑。
BACKGROUND: 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.
METHODS: 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.
CONCLUSIONS: 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.
CONCLUSIONS: 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.