Which ultrasound features are most consistent with a hematoma in the breast?

• A. Varied Echogenicity From Acute Hyper-Echogenic to Complex as It Ages
• B. A Purely Anechoic Lesion With Posterior Enhancement
• C. A Solid, Vascular Tumor
• D. A Simple Cyst

Answer: (A)

Hematoma in the breast changes its ultrasound appearance as it ages because the blood products break down and organize over time. In the immediate aftermath, clotted blood tends to be hyper-echoic (bright) on ultrasound. As the hematoma evolves, it becomes more complex, with internal debris and septations, giving a heterogeneous or mixed-echo appearance. Later, it may become more liquefied and appear more anechoic or multiloculated, reflecting different stages of resolution. This variability—ranging from acute bright echoes to complex, evolving internal echoes—best matches the description of a hematoma.

A purely anechoic lesion with posterior enhancement would suggest a simple cyst or seroma rather than a hematoma, which typically does not remain uniformly anechoic. A solid, vascular tumor would usually show internal vascular flow on Doppler, which a hematoma generally lacks. A simple cyst is characterized by a single anechoic appearance with posterior enhancement and no internal echoes, which again does not fit the evolving nature of a hematoma.