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. 2012 Jul 4:6:186.
doi: 10.1186/1752-1947-6-186.

Particle embolization to control life-threatening hemorrhage from a fungating locally advanced breast carcinoma: a case report

John M Moriarty  1 , Minzhi Xing, Christopher T Loh
Affiliations

Particle embolization to control life-threatening hemorrhage from a fungating locally advanced breast carcinoma: a case report

John M Moriarty et al. J Med Case Rep. .

Abstract

Introduction: Sudden severe hemorrhage from locally advanced fungating breast carcinoma and its associated cutaneous lesions is rarely reported. Transcatheter arterial embolization has been used widely in the setting of intractable neoplastic hemorrhage arising from primary and metastatic tumors of the lung, liver, kidney, and gastrointestinal tract. Here, we detail the use of transcatheter arterial embolization in controlling torrential hemorrhage in a patient with advanced invasive breast cancer and multiple comorbidities.

Case presentation: We report the case of a 28-year-old African-American woman who presented with acute torrential hemorrhage from a high-grade invasive ductal breast carcinoma. A computed tomography scan demonstrated a 14cm mass with extensive muscle, fascial, and cutaneous invasion. Owing to the extent of invasion and multiple comorbidities, she was deemed to be unsuitable for surgical management. Selective angiography of the left internal mammary artery revealed no tumoral blush, extravasation, or pseudoaneurysm. Transcatheter arterial embolization was undertaken, and complete occlusion of the vessel was demonstrated. No further episodes of hemorrhage occurred.

Conclusions: Though rare, sudden severe hemorrhage from advanced breast cancer may be definitively managed by embolization alone and thus surgery may be avoided.

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Figures

Figure 1
Figure 1
Photograph of the left side of the thorax demonstrates an extremely large, fungating breast carcinoma with extensive cutaneous ulceration.
Figure 2
Figure 2
Axial contrast-enhanced computed tomography image of the thorax demonstrates a 14cm enhancing breast mass (arrow). Branch vessels of the left internal mammary artery (arrowhead) passing anteriorly into the mass were noted.
Figure 3
Figure 3
Selective digital subtraction angiogram of the left internal mammary artery shows multiple feeding branches to the anterior chest wall and left breast.
Figure 4
Figure 4
Pre-particle embolization images of the left internal mammary artery demonstrate proximal occlusion of the vessel and its mammary branches.
Figure 5
Figure 5
Post-particle embolization images of the left internal mammary artery demonstrate proximal occlusion of the vessel and its mammary branches.
Figure 6
Figure 6
Selective right intercostal artery angiography was performed through a 5-French Michelson catheter from the supreme right intercostal artery to the right 12th intercostal artery. A common trunk of the right ninth and 10th intercostal arteries is pictured. No discrete bleeding source or arterial irregularity was identified.
Figure 7
Figure 7
Selective injection of the left lateral thoracic artery failed to demonstrate any discrete communication with the breast mass or bleeding site.
See this image and copyright information in PMC

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