A Case of Traumatic Intramammary Bleeding Cured by Hematoma Removal and Pressure Hemostasis under Local Anesthesia

Abstract

A 54-year-old woman was injured in a two-vehicle traffic accident. At the time of contact with the ambulance crew, she was conscious and able to walk, but her left anterior chest became swollen over time, and a decrease in blood pressure was observed in the ambulance. On arrival at the hospital, marked swelling, tenderness, and subcutaneous hemorrhagic spots were observed at the left breast. She was in shock with a blood pressure of 73/36 mmHg, a pulse of 108 beats/min, and a respiratory rate of 27 beats/min. Contrast-enhanced computed tomography showed a giant hematoma and extravasation of contrast medium in her left breast, suggesting active bleeding from the left lateral thoracic artery branch. Considering the high risk associated with administering general anesthesia to a patient with unstable hemodynamics and the possibility that endovascular treatment might not reliably reach the bleeding point, the massive hematoma in front of the pectoralis major muscle was removed under local anesthesia, followed by application of gauze and compression fixation with an elastic bandage. She was decompressed the next day and found to have achieved hemostasis ; her drain was removed on postoperative day 6, and she was discharged the next day. Thus, a case of traumatic intramammary bleeding cured by hematoma removal and compression hemostasis under local anesthesia is reported.