Sequential management of traumatic breast hematoma with an anatomically evident flail segment: a case report

Traumatic breast hematoma is an uncommon injury following blunt chest trauma, but associated chest wall injuries may complicate treatment planning. We report a woman in her 70s who sustained a frontal motor vehicle collision. Contrast-enhanced computed tomography (CT) demonstrated a massive right breast hematoma with active extravasation from a branch of the internal mammary artery and an anatomically evident flail segment involving the right third through fifth ribs. Emergency transcatheter arterial embolization achieved complete hemostasis. Because preoperative CT suggested that the hematoma temporarily stabilized the injured chest wall, hematoma evacuation, and possible surgical stabilization of rib fractures (SSRF) were planned through a single inframammary incision. After hematoma evacuation, manual compression demonstrated abnormal mobility of the flail segment, confirming mechanical chest wall instability, and SSRF was completed through the same incision. Careful CT assessment and intraoperative evaluation may facilitate surgical planning in patients with combined breast and chest wall trauma.