Acquired Arteriovenous Fistula of the Breast Following Ultrasound Guided Biopsy of Invasive Ductal Carcinoma
A 58-year-old female presented for her annual screening mammogram. At that time, a new mass was identified in the right breast at 9 o’clock, middle depth region. Targeted ultrasound showed a 1.7 cm × 1.4 cm × 1.3 cm irregular hypoechoic mass to correlate with the mammographic abnormality. Ultrasound guided biopsy of the right breast mass was subsequently performed with a 14 gauge vacuum assisted biopsy device. At the time of biopsy, a significant amount of bleeding was noted after the final core biopsy. Bleeding was controlled with manual compression. A marker clip was placed. Post-procedure mammograms demonstrated a large hematoma at the biopsy site with the marker clip associated with the mass. Pathology results showed this mass represented invasive ductal carcinoma. Subsequent magnetic resonance imaging (MRI) demonstrated a new round enhancing mass with rapid wash-in and rapid wash-out characteristics. The mass measuring 0.8 cm × 0.8 cm was seen at the site of biopsy adjacent to the enhancing known cancer that measured up to 2.1 cm []. Large vessels were seen coursing to and from the new arterially enhancing mass []. Clinical examination revealed a new pulsatile mass within the right breast.\nUltrasound examination of the breast was performed to evaluate the new suspected vascular mass. A vascular mass was seen adjacent to the known carcinoma within a region of hematoma and measured 0.9 cm × 0.8 cm × 0.6 cm []. Two large vessels were seen in continuity with this vascular mass. A high velocity flow, low resistance Doppler wave form was seen in the mass consistent with an AVF []. Arterialization of the draining vein was also noted []. The vascular mass and adjacent known neoplasm were excised using intraoperative ultrasound. The pathology demonstrated invasive ductal carcinoma adjacent to a vascular lesion.