Progressive seatbelt-related intramammary hematoma requiring surgical evacuation in an obese female: a case report.

Seatbelt-related breast trauma is an uncommon consequence of motor vehicle collisions. Most injuries present as localized contusion or hematoma, whereas progressive breast hematomas requiring surgical intervention are exceedingly rare, particularly in patients without coagulation abnormalities. Obesity may further alter trauma biomechanics and influence hematoma progression. A 49-yearold woman with obesity (Body Mass Index: 38 kg/m2) presented to the emergency department one hour after a motor vehicle collision with left breast swelling, firmness, and ecchymosis. Body temperature, blood pressure, and heart rate were within normal limits. Contrast-enhanced computed tomography (CT) demonstrated a 62×52 mm breast hematoma without evidence of arterial extravasation. Conservative treatment with compression therapy was continued for three days; however, pain and breast tension progressively increased, and ultrasonography demonstrated mild enlargement of the hematoma. On the fourth day, minimally invasive surgical evacuation was performed, yielding a large volume of organized hematoma. Postoperatively, symptoms improved rapidly. At two-week follow-up, breast symmetry was fully restored with no residual deformity. This case represents a rare presentation of seatbelt-related breast trauma: a progressive breast hematoma without active bleeding that ultimately required surgical evacuation. Obesity may have contributed to the failure of conservative management and earlier clinical progression. Early recognition of symptom worsening is essential to optimize cosmetic and functional outcomes.