Hospital: Hospital Universitario de Getafe.
Ciudad:
Nº:
Aut@r o Autores: G. Díaz Ibero, A. Berral Santana, I. Cedrun Sitges, G. Ugena Diaz, J. Vega Villar, V. San Martin Luque.,
Presentación:
A 36-years-old male suffered a direct impact on his right lower limb during a rugby game. He presented to the Emergency Department complaining of progressive leg pain and swelling. He did not have any other comorbidities. Blood pressure was 123/71 mmHg and heart rate was 81 bpm at arrival. Physical examination showed a swollen right leg with a 8 cm hematoma in the anterior compartment, superficial abrasions and lacerations with some areas of necrotic skin close to the hematoma. Ankle flexion and extension movements were preserved, and posterior tibialis and dorsalis pedis pulses were palpable. Blood analysis revealed an elevated D-Dimer level (1,03 mg/L, normal < 0.5mg/L). Ultrasound (US) was performed showing a cystic lesion close to the posterior tibial artery. Doppler US revealed a swirling motion (“yin-yang” sign) inside the cystic lesion and a communication channel with the artery showing a bidirectional flow (to-and-fro) consistent with a pseudoaneurysm (2). Computer Tomographic Angiography (CTA) demonstrated a contrast material-filled sac and a hyperdense contrast extravasation blush consistent with arterial bleeding from a ruptured pseudoaneurysm.(3) Emergent artery ligation was performed and hematoma drainage were realized. There was no further complications. The patient was discharged five days later.
Discusión:
Arterial pseudoaneurysms may result from iatrogenic causes, inflammation or, less commonly, trauma. Blood dissects the artery wall and forms a perfused sac contained by the media or adventitia. (1) Pseudoaneurysm may be asymptomatic or they can lead to compression of adjacent structures, and ischemia of the surrounding tissues due to vascular compromise. In addition the pseudoaneurysm may rupture causing severe morbidity. (1) Conventional angiography remains the diagnostic gold standard, but Doppler US and CTA are useful noninvasive alternatives in the diagnosis of pseudoaneurysms. (2) (3) Therapeutic options range from conservative follow-up in asymptomatic cases to surgical repair in symptomatic aneurysm (intermittent or continuous bleeding). (1) There is an upward tendency to use minimal invasive procedures such as percutaneous US-guided Thrombin injection or endovascular techniques.
Conclusión:
Arterial pseudoaneurysms may result from iatrogenic causes, inflammation or, less commonly, trauma. Blood dissects the artery wall and forms a perfused sac contained by the media or adventitia. (1) Pseudoaneurysm may be asymptomatic or they can lead to compression of adjacent structures, and ischemia of the surrounding tissues due to vascular compromise. In addition the pseudoaneurysm may rupture causing severe morbidity. (1) Conventional angiography remains the diagnostic gold standard, but Doppler US and CTA are useful noninvasive alternatives in the diagnosis of pseudoaneurysms. (2) (3) Therapeutic options range from conservative follow-up in asymptomatic cases to surgical repair in symptomatic aneurysm (intermittent or continuous bleeding). (1) There is an upward tendency to use minimal invasive procedures such as percutaneous US-guided Thrombin injection or endovascular techniques.
Bibliografía:
– Marron CD, Mckay D, Johnston R, McAteer E, Stirling WJI. Pseudoaneurysm of the anterior tibial artery, a rare cause of ankle swelling following sports injury. BMC emergeny Medicine. 2005, 5:9 – Pagliariccio G, Catalini R, Giantomassi L, Angelini A. Man