Breast hematoma

Breast hematoma can result from preceding direct trauma, surgery, biopsy (rare) or contusion and can be easily misinterpreted as other lesions such as breast malignancy if the correct clinical context is not taken into account. They can rarely occur spontaneously, especially in those with coagulopathy.

There is usually but not always a history of trauma. Breast hematomas are a common finding post motor vehicle collision due to seat belt injuries.

Radiographic features

It is reported to have a variable radiographic spectrum on both mammography and ultrasound. The correct clinical context is crucial in image interpretation.

Mammography

The reported mammographic spectrum includes ²:

• single nodule
• patchy nodule
• diffusely increased glandular density (the most common appearance)
• radiolucent nodule(s)
• nodule(s) with calcification

Through the passing of time, there may evidence of fat necrosis in the region.

Breast ultrasound

Ultrasound features can be variable. The reported sonographic spectrum includes:

• fluid collection
• solid nodule
• cystic nodule
• diffuse parenchymal abnormalities
• calcified nodule

Treatment and prognosis

Although benign, it requires careful interpretation in the correct clinical context. A hematoma may eventually evolve into a scar or cystosteatonecrosis (fat necrosis). Most hematomas resolve within 2-4 weeks ⁵. Some hematomas may undergo liquefaction and develop into a breast seroma.

In the typical clinical setting, often no further evaluation is required. However, in unusual cases (e.g. no definite antecedent trauma), short term (~6-8 week) follow-up is recommended.