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Challenge number 11.

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So this is a patient, this is their post biopsy study

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and you can see that they have a reasonable

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sized hematoma here.

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And then when we come to have their film done later,

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it's an even bigger hematoma.

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And this is quite frequent with Emma guided biopsies.

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We see it more, um, with um, a,

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um, Emma guided biopsy than we tend to with stereo biopsies.

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Probably for a couple of things. One,

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we take more, um, biopsies.

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We typically take 12 rather than six as our first go

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with an MR guided biopsy.

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And that's because of the concerns about sampling errors.

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You know, with a stereo you can take a radiograph

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of the specimens, you know, you've got the calcs,

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you know you've got the mass.

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Um, you can't do that with Mr.

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So take more tissue to reduce your sampling error.

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Use lidocaine with epinephrine.

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Um, in the recent lido with epinephrine shortage,

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we stopped using it in stereotactic biopsy routinely

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as patients are on some form of anticoagulation.

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Um, but we did continue using on Mr guided biopsies.

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We saved it for that. Um,

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often on the immediate post study, post biopsy study,

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you'll see that there is a hematoma there

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or some form of a hematoma

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and the fluid that you used for the um,

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uh, vacuum procedure.

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And in fact, I don't suck it out at this point

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before I scan to check the adequacy of my biopsy

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'cause I like to see a cavity there

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'cause it can help me show where my biopsy position was.

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But I will go put the, uh, needle back in

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before I place the clip.

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Just vacuum that cavity out thoroughly turn your cavity

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around through 360 degrees to make sure

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that it's nice and sucked dry.

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And it's, uh, remarkable how much

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that can really help in that case.

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Generally speaking. The other,

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and one of the other reasons that, um, we tend to get more,

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um, hematomas with Emma guided biopsies than we do

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with other types of biopsies is the,

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the whole procedure is much longer.

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You know, they're going in and outta the scanner and so on.

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So it can be sitting there bleeding for longer.

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It takes them longer to get out afterwards for you

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to get compression on,

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but generally speaking, prolonged compression

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is gonna stop the bleeding.

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But sometimes it does have to be very, um, prolonged.

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And if they have bled significantly,

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I would highly recommend that you

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place a compression dressing.

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You may have to skip doing your, um,

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post-procedural mammogram and delay it to another day.

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If you've spent a long time stopping the bleeding,

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you're probably not gonna want

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to start mucking things about at that point.

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And every few years we do have somebody who ends up going

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to surgery, um, to have a source of bleeding tied off.