Arterial contrast extravasation in severe seat belt-related female breast trauma on CT: Conservative management at a level 1 trauma centre

Breast Trauma: A United States-Based Epidemiological Study From 2016 to 2019

Background  Breast trauma is an often under-recognized injury, especially in female polytrauma patients. The purpose of this study was to assess the prevalence of breast injuries and their association with injury severity score (ISS) in trauma patients nationally.  Method A retrospective review was performed using data from the National Trauma Data Bank® (NTDB®) from 2016 to 2019, using all applicable International Classification of Diseases (ICD) codes for three outlined subgroups (abrasions, contusions, and open wounds/punctures/lacerations) with minors excluded. All continuous variables were tested as non-normally distributed, and all test results for continuous variables used the Kruskal-Wallis test. All categorical variables were tested using a chi-squared test. Results  Patients with traumatic breast abrasions and contusions had a higher rate of intensive care unit (ICU) admissions (23.8%; n=395 and 25.3%; n=48, respectively) compared to patients with open wounds/punctures/lacerations (13.6%; n=205). Patients with abrasions and contusions to the breast had a significantly higher ISS compared to those with visible open wounds/punctures/lacerations (9 and 9, vs 5, p <0.001). Mortality rates were highest among patients with breast abrasions and contusions, 15% (n=213) and 14% (n=23), respectively, compared to patients with open wounds/punctures/lacerations at 11% (n=132), p<0.017. Conclusion  Traumatic breast abrasions and contusions were associated with higher rates of ICU admission, elevated ISS, and overall mortality compared to open breast wounds, punctures, or lacerations. This indicates the importance of traumatic breast injuries as a prognostic indicator in the standard workup of a trauma patient.

Underreported and underrecognized: a comprehensive imaging review of breast injury

Breast injury is commonly encountered yet it remains significantly underreported. Injury to the breast may arise from either primary mechanisms or secondary or iatrogenic mechanisms. Primary mechanisms of breast injury include blunt force, seat-belt, penetrating, and thermal injury. Secondary or iatrogenic mechanisms of breast injury include breast biopsy or intervention as well as operative intervention and cardiopulmonary resuscitation. The severity of breast injury arising from these mechanisms is broad, ranging from breast contusion to avulsion. Sequelae of breast injury include fat necrosis and Mondor's disease. Radiologists play an integral role in the evaluation and management of breast injury both in the acute and non-acute settings. In the acute setting, radiologists must be able to recognize breast injury arising from primary mechanisms or iatrogenic or secondary mechanisms and to identify rare but potentially life-threatening complications promptly to ensure timely, appropriate management. In the non-acute setting, radiologists must be able to discern the sequalae of breast injury from other processes to prevent potentially unnecessary further evaluation and intervention. Nonetheless, though breast injury is commonly encountered there remain few guidelines and a lack of established recommendations for the evaluation and management of breast injury. We provide a comprehensive multi-modality imaging review of breast injury arising in the acute setting as well as the sequela of breast injury arising in the non-acute setting. Moreover, we provide an overview of the management of breast injury.

Changes to breast structure and function across a woman's lifespan: Implications for managing and modeling female breast injuries

BACKGROUND

Female breasts change throughout a woman's life in response to fluctuating hormonal influences. Individuals managing active women and those modeling female breasts must understand these structural and functional changes across a female's lifespan because these changes affect breast injuries sustained by women.

METHODS

We initially review female breast structure and function and then describe how breast structure changes across a woman's lifespan. Key studies about direct contact and frictional breast injuries are then summarized. Limitations of current breast injury research, gaps in knowledge about breast injuries incurred by specific populations, and the lack of breast injury models are also highlighted.

FINDINGS

With minimal anatomical protection, it is unsurprising that breast injuries occur. Although research about breast injuries is scant, direct contact during blunt force trauma to the anterior chest wall and frictional breast injuries have been reported. There is a lack, however, of research documenting the incidence and severity of breast injuries incurred in occupational settings and in women's sports. Therefore, to design effective breast protective equipment, we recommend research to model and investigate the mechanisms and forces involved in breast injuries, particularly injuries sustained during sport.

INTERPRETATION

This unique review summarizes how female breasts change over a woman's life span, with implications for breast injuries sustained by females. Knowledge gaps about female breast injuries are highlighted. We conclude by recommending research required to develop evidence-based strategies to improve how we classify, prevent, and clinically manage breast injuries sustained by females.

SUMMARY

We review changes to the breast across a woman's lifespan, highlighting implications for managing and modeling female breast injuries.

A Seat Belt Injury Causing a Large Breast Hematoma: A Case Report

Seat belts with shoulder restraints have decreased the frequency of life-threatening severe chest trauma caused by car accidents. However, the introduction of seat belt legislation has led to an increase in a specific pattern of blunt trauma known as seat belt syndrome, which includes rib, clavicle, spine, and sternum fractures, as well as rupture of hollow pelvic and abdominal viscera, mesenteric tears, and major vessel injuries. The shoulder restraint part of the three-point seat belt commonly rests near or over the female and male breast. A 54-year-old female presented to our emergency department complaining of swelling and pain in her left breast immediately after a traffic accident. The patient had used a seat belt with a shoulder restraint. Bruising was noted along her chest where there had been seat belt contact. Her breast hematoma was most likely caused by breast tissue compression between her rib and the seat belt. Contrast-enhanced computed tomography demonstrated a sizable breast hematoma with active arterial contrast material extravasation, as well as multiple left rib fractures. The patient was conservatively treated with analgesic and anti-inflammatory drugs. Complete resolution was achieved, and her breast returned to its normal appearance. Although endovascular treatment and surgical hemostasis have been proposed for the treatment of breast injuries with active bleeding, conservative treatment such as compression hemostasis may be feasible.