RESUMEN
The yin-yang sign, also known as the Pepsi sign, is used to describe the classic appearance of bidirectional blood flow within an aneurysm or pseudoaneurysm sac on color Doppler ultrasound. The corresponding spectral Doppler finding is a "to-and-fro" waveform, caused by inflow to the aneurysm/pseudoaneurysm sac during systole and outflow during diastole. It is important to recognize this sign in order to quickly identify the presence of an aneurysm or pseudoaneurysm and prevent complications such as expansion and rupture.
Asunto(s)
Aneurisma Falso , Aneurisma , Masculino , Humanos , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/etiología , Yin-Yang , Aneurisma/complicaciones , Ultrasonografía DopplerRESUMEN
We present an unusual case of ruptured subclavian artery pseudoaneurysm following hydrotherapy and shoulder massage session on a background of clavicle non-union.Following a clavicle fracture 16 years ago, which was managed conservatively, a woman in her 30s presents over a decade later with a ruptured subclavian artery pseudoaneurysm.The original midshaft clavicle fracture was sustained 16 years ago. Conservative management was agreed, and she was discharged. Six years ago, she developed a small subclavian artery pseudoaneurysm which was kept under surveillance for 12 months with no active intervention required.Over the following years, she continued to have intermittent shoulder girdle discomfort and neuropathic symptoms. On this presentation, after a sports massage, she presented with rapid-onset supraclavicular and axillary swelling. This was diagnosed as a ruptured subclavian artery pseudoaneurysm and was treated with emergency radiological-guided stenting and subsequent internal fixation of the clavicle non-union.The patient then attended regular orthopaedic and vascular follow-up to ensure her clavicle fracture unites and the graft remains patent.We discuss the case presentation and management of this unusual injury.
Asunto(s)
Aneurisma Falso , Fracturas Óseas , Femenino , Humanos , Hombro , Clavícula/lesiones , Arteria Subclavia/diagnóstico por imagen , Arteria Subclavia/cirugía , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/etiología , Aneurisma Falso/terapia , Fracturas Óseas/complicaciones , Fracturas Óseas/diagnóstico por imagen , Fracturas Óseas/terapia , Fijación Interna de Fracturas , MasajeRESUMEN
Pseudoaneurysm is a rare complication after intertrochanteric fracture fixation. Herein, we present a rare case of late development of a pseudoaneurysm with silent clinical symptoms. The case was a 91-year-old woman treated with proximal femoral nailing and cerclage wiring. Postoperatively, the patient was able to ambulate with a walker without abnormal symptoms. During the follow-ups, the radiographic images showed progressive cortical scalloping on the medial femoral shaft. Ultrasonography revealed a yin-yang sign, and a CT scan confirmed a pseudoaneurysm at the profunda femoris artery (PFA). In this case, many possible causes of pseudoaneurysm were hypothesized. We showed that the excessive displaced, long spiral pattern of an intertrochanteric fracture, which was irreducible by a closed technique, is the risk of a PFA injury. An atherosclerotic vessel was seen in preoperative radiography, indicating poor vessel elasticity which may be a risk of vessel tear during fracture reduction using multiple reduction instruments in excessive displaced fracture. Moreover, over-penetration when drilling should not be overlooked. We also discuss the predisposing factors, surgical techniques which may lead to this type of PFA injury and summarize the literature of pseudoaneurysms related to intertrochanteric fracture fixation.
Asunto(s)
Aneurisma Falso , Fijación Intramedular de Fracturas , Fracturas de Cadera , Femenino , Humanos , Anciano de 80 o más Años , Fijación Intramedular de Fracturas/efectos adversos , Fijación Intramedular de Fracturas/métodos , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/etiología , Aneurisma Falso/cirugía , Resultado del Tratamiento , Fijación Interna de Fracturas/métodos , Fracturas de Cadera/cirugía , Fracturas de Cadera/complicaciones , Enfermedad Iatrogénica , Clavos Ortopédicos/efectos adversosRESUMEN
Pseudoaneurysms are vascular abnormalities caused by a damaging force on an arterial wall, resulting in a persistent extravasation of blood into the surrounding tissue, which can be the result of infection, inflammation, trauma or any iatrogenic procedure. The incidence of extremity artery pseudoaneurysms is rising because of increased number of endovascular procedures. As a number of complications are associated with these false aneurysms, it is important to know the treatment modalities available. Ultrasound is the most common method of diagnosing extremity pseudoaneurysm because of their superficial location. Computed tomographic angiography is the next investigation of choice as it has three-dimensional capability and can help evaluate the vascular bed. Digital subtraction angiography is rarely used for diagnosis alone, and is used only when a therapeutic procedure is planned. Treatment of these pseudoaneurysms has shifted from open surgical procedures to minimally invasive treatment in recent years. The different techniques for tackling these lesions include ultrasound-guided compression, percutaneous thrombin or glue embolisation and endovascular coil or stent graft placement. In this pictorial essay, we review the different treatment modalities so that an interventional radiologist is aware of all the treatments he can offer when confronted with these lesions.
Asunto(s)
Aneurisma Falso , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/terapia , Angiografía de Substracción Digital , Extremidades , Humanos , Masculino , Radiología Intervencionista , Trombina , Resultado del TratamientoRESUMEN
This case discusses an elderly female who presented acutely with compromised profunda femoris pseudoaneurysm and massive haematoma five weeks after dynamic hip screw insertion for a left neck of femur fracture. The only precipitating factor leading to this presentation was ongoing physiotherapy. She was referred from a rehabilitation hospital to the nearest vascular surgical unit for acute and definitive surgical intervention. Post-operatively, she fared incredibly well, regaining her baseline level of functioning. History taking is complex in a patient with dementia. Clinical examination should follow with a focused approach to the site of recent operation and also where complications are likely to manifest when an alteration from baseline cognitive function is noted. This is of course in addition to the complete work up required from a holistic perspective with any acute deterioration. Imaging should be arranged and prompt referral made if a treatable acute cause is identified. It is imperative to involve family and/or next of kin if possible, but this should not impede prompt decision-making in the patient's best interests by the clinical team if delays are likely to occur.
Asunto(s)
Aneurisma Falso/diagnóstico por imagen , Arteria Femoral/diagnóstico por imagen , Fracturas del Cuello Femoral/cirugía , Fijación Interna de Fracturas/rehabilitación , Fracturas por Avulsión/diagnóstico por imagen , Hematoma/diagnóstico por imagen , Hemorragia Posoperatoria/diagnóstico por imagen , Anciano , Aneurisma Falso/cirugía , Tornillos Óseos , Demencia Vascular/complicaciones , Femenino , Arteria Femoral/cirugía , Fracturas del Cuello Femoral/complicaciones , Fracturas por Avulsión/cirugía , Hematoma/complicaciones , Fracturas de Cadera/diagnóstico por imagen , Fracturas de Cadera/cirugía , Humanos , Modalidades de Fisioterapia , Hemorragia Posoperatoria/complicaciones , Hemorragia Posoperatoria/cirugía , UltrasonografíaRESUMEN
The pseudoaneurysm (PA) is a perfused sac directly connecting with the arterial lumen by an interruption of the vessel wall continuity, more commonly secondary to trauma or iatrogenic causes. Aim of our study was to determine the accuracy and usefulness of Doppler techniques in the diagnosis of peripheral iatrogenic PAs secondary to minimally invasive procedures. From a three year prospective research, 20 Duplex Ultrasound (DUS) studies in as many patients presenting with periarterial pulsating mass clinically suspected for PA secondary to minimally invasive procedures were selected. The PA final diagnosis was confirmed by angiography in 12 patients (60% cases), by computed tomography angiography in 5 patients (25%), by surgery in 2 patients (10%), and by magnetic resonance angiography in 1 patient (5%). The vessels involved by PA formation were: common femoral artery in 8 cases (40%); superficial femoral artery in 4 cases (20%); brachial artery in 3 cases (15%); popliteal artery in 2 cases (10%); superficial temporal artery (STA) in 2 cases (10%); dorsal medial digital artery of the foot in 1 case (5%). Our study confirmed the usefulness of doppler techniques in the diagnosis of peripheral iatrogenic PAs. Specifically, a sensitivity of 90-95%, a specificity of 100% and predictive values of 100% (VPP) and 83-90% (VPN) were reported. The radiologist must always suspect a PA in the differential diagnosis of lesions contiguous to an artery vessel. This is to prevent potential complications such as e.g. massive haemorrhage. In this order, DUS allows a careful selection of patients who require to undergo in-depth imaging methods or surgical therapy, thus contributing to a significant reduction of contrast medium and exposure to ionizing radiation.
Asunto(s)
Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/etiología , Procedimientos Quirúrgicos Mínimamente Invasivos/efectos adversos , Ultrasonografía Doppler Dúplex , Ultrasonografía Doppler de Pulso , Adulto , Anciano , Femenino , Humanos , Enfermedad Iatrogénica , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/terapia , Factores de RiesgoRESUMEN
Online supplemental material is available for this article.
Asunto(s)
Aneurisma Falso/diagnóstico por imagen , Fístula Arteriovenosa/diagnóstico por imagen , Arterias Temporales , Traumatismos Cerrados de la Cabeza/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Arterias Temporales/diagnóstico por imagen , Arterias Temporales/lesiones , Ultrasonografía Doppler en ColorRESUMEN
We report the case of an 83-year-old man on rivaroxaban treatment, with pain in right shoulder, back of the upper arm, forearm and wrist, and inability to extend the wrist and fingers, as the result of an injury. The radiographs were normal, but thoracic CT showed an axillary artery pseudoaneurysm and a secondary hematoma that compressed the brachial plexus. This should be borne in mind in patients with painful shoulder, treated with anticoagulant therapy and without associated radiographic changes.
Asunto(s)
Aneurisma Falso/inducido químicamente , Anticoagulantes/efectos adversos , Arteria Axilar , Hematoma/inducido químicamente , Rivaroxabán/efectos adversos , Dolor de Hombro/etiología , Tomografía Computarizada por Rayos X , Anciano de 80 o más Años , Aneurisma Falso/complicaciones , Aneurisma Falso/diagnóstico por imagen , Arteria Axilar/diagnóstico por imagen , Arteria Axilar/patología , Hematoma/complicaciones , Hematoma/diagnóstico por imagen , Humanos , MasculinoAsunto(s)
Aneurisma Falso/terapia , Cianoacrilatos/administración & dosificación , Embolización Terapéutica , Arterias Epigástricas/lesiones , Aceite Etiodizado/administración & dosificación , Enfermedad Iatrogénica , Ultrasonografía Intervencional , Lesiones del Sistema Vascular/terapia , Anciano , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/etiología , Arterias Epigástricas/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Lesiones del Sistema Vascular/diagnóstico por imagen , Lesiones del Sistema Vascular/etiologíaAsunto(s)
Aneurisma Falso/terapia , Aneurisma Roto/terapia , Tomografía Computarizada de Haz Cónico , Embolización Terapéutica , Enbucrilato/administración & dosificación , Aceite Etiodizado/administración & dosificación , Hemorragia/terapia , Radiografía Intervencional/métodos , Anciano de 80 o más Años , Aneurisma Falso/diagnóstico por imagen , Aneurisma Roto/diagnóstico por imagen , Hemorragia/diagnóstico por imagen , Humanos , Masculino , Punciones , Resultado del TratamientoAsunto(s)
Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/microbiología , Geotricosis/diagnóstico por imagen , Enfermedades del Bazo/diagnóstico por imagen , Enfermedades del Bazo/microbiología , Aneurisma Falso/terapia , Antifúngicos/uso terapéutico , Angiografía por Tomografía Computarizada , Diagnóstico Diferencial , Embolización Terapéutica , Fungemia/diagnóstico por imagen , Fungemia/microbiología , Fungemia/terapia , Geotricosis/terapia , Humanos , Huésped Inmunocomprometido , Leucemia Mieloide Aguda/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Enfermedades del Bazo/terapia , Ultrasonografía Doppler en ColorRESUMEN
OBJECTIVE: To describe the clinical presentation of arterial pseudoaneurysms following total knee arthroplasty (TKA) and their diagnostic imaging features on ultrasound and magnetic resonance angiography (MRA) in 7 patients. MATERIALS AND METHODS: A search of our radiology report database from 2007 to 2017 yielded 7 patients with a pseudoaneurysm diagnosed by imaging after TKA. Clinical notes and imaging were reviewed. RESULTS: All 7 patients were male and ranged in age from 53 to 68 (mean 61) years. All patients presented with a painful swollen knee and hemarthrosis within the first month following surgery. Five patients presented after primary TKA. One patient presented after explantation for septic arthritis and another after partial synovectomy for septic arthritis without explantation. Ultrasound identified the pseudoaneurysm as a hypoechoic or hyperechoic mass with a "yin-yang" appearance of turbulent arterial flow and associated complex joint effusion. On MRA, the pseudoaneurysm was a mass next to a parent artery showing avid contrast enhancement in the arterial phase that persisted into the venous phase and washed out in the late venous phase. Six pseudoaneurysms arose from lateral geniculate arteries and 1 from a medial geniculate artery. There were no popliteal artery pseudoaneurysms. Five patients were treated endovascularly, 1 patient thrombosed without intervention, and 1 patient was treated with open surgery. CONCLUSION: Pseudoaneurysm is a potential source of a painful swollen knee with hemarthrosis or a drop in hematocrit after TKA and can be identified with either ultrasound or MRA.
Asunto(s)
Aneurisma Falso/diagnóstico por imagen , Artroplastia de Reemplazo de Rodilla , Angiografía por Resonancia Magnética/métodos , Complicaciones Posoperatorias/diagnóstico por imagen , Ultrasonografía/métodos , Anciano , Hemartrosis/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana EdadAsunto(s)
Aneurisma Falso/complicaciones , Ronquera/etiología , Síndrome de Dificultad Respiratoria/etiología , Arteria Subclavia/diagnóstico por imagen , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/terapia , Angiografía por Tomografía Computarizada , Embolización Terapéutica/métodos , Enbucrilato/administración & dosificación , Aceite Etiodizado/administración & dosificación , Humanos , Masculino , Persona de Mediana Edad , Cuello , Ultrasonografía Doppler en ColorRESUMEN
Los pseudoaneurismas son una causa infrecuente de masa palpable en cabeza y cuello, habitualmente secundarios a procedimientos intervencionales; trauma e infeccioso son casos aislados. Caso Clínico. Se presenta el caso de un niño de 14 años que luego de haber sufrido un trauma contuso cortante en la región preauricular izquierda intervenido quirúrgicamente, desarrolla al mes un aumento de volumen pulsátil tras un trauma menor en la zona. En la ecografía se aprecia el signo del yin yang, indicador de pseudoaneurisma. Se realiza en pabellón el vaciamiento del pseudoaneurisma y posterior sutura vascular sin incidentes. Discusión. Pese a la baja frecuencia de pseudoaneurisma como causa de masa en cabeza y cuello, se debe considerar como diagnóstico diferencial en el contexto de masas pulsátiles post traumáticas, de horas a días de evolución. El estudio de elección es la ecografía doppler y el Gold Standard del manejo es quirúrgico con sutura vascular.
Pseudoaneurysms are an infrequent cause of palpable mass in the head and neck; usually secondary to invasive procedures; trauma and infectious causes are rare. Clinical Case. We present the case of a 14-year-old boy who, after suffering a blunt contusive trauma in the left preauricular region surgically treated, develops a month later a pulsatile volume increase after a minor trauma in the area. Ultrasound shows the yin yang sign, indicator of pseudoaneurysm. The emptying of the pseudoaneurysm and subsequent vascular suture was performed without incident. Discussion. Despite the low frequency of pseudoaneurysm as a cause of mass in the head and neck, it should be considered as a differential diagnosis in the context of post-traumatic pulsatile masses, from hours to days of evolution. The study of choice is Doppler ultrasound and the Gold Standard treatment is surgery with vascular suture.
Asunto(s)
Humanos , Masculino , Adolescente , Arterias Temporales/lesiones , Aneurisma Falso/diagnóstico por imagen , Arterias Temporales/cirugía , Arterias Temporales/diagnóstico por imagen , Aneurisma Falso/cirugía , Aneurisma Falso/etiología , Ultrasonografía Doppler en Color , Traumatismos CerebrovascularesRESUMEN
We present the case of a mixed martial arts (MMA) cage fighter who presented to the emergency department with a right sided common carotid artery pseudoaneurysm as a result of a neck trauma at an MMA event. We discuss the management of blunt force neck trauma, differential diagnosis, imaging findings and review the literature on blunt cerebrovascular injury following blunt force injury to the neck.
Asunto(s)
Aneurisma Falso/diagnóstico por imagen , Traumatismos de las Arterias Carótidas/diagnóstico por imagen , Artes Marciales/lesiones , Cartílago Tiroides/diagnóstico por imagen , Cartílago Tiroides/lesiones , Heridas no Penetrantes/diagnóstico por imagen , Adulto , Aneurisma Falso/etiología , Aneurisma Falso/cirugía , Traumatismos de las Arterias Carótidas/etiología , Traumatismos de las Arterias Carótidas/cirugía , Angiografía por Tomografía Computarizada , Diagnóstico Diferencial , Servicio de Urgencia en Hospital , Humanos , Imagenología Tridimensional , Masculino , Radiografía , Cartílago Tiroides/cirugía , Heridas no Penetrantes/etiología , Heridas no Penetrantes/cirugíaRESUMEN
OBJECTIVE/BACKGROUND: Pseudoaneurysm formation occurs in 2-10% of hemodialysis arteriovenous grafts (AVGs). Surgical repair often requires pseudoaneurysm resection, interposition graft placement, and insertion of a catheter as a bridge. Endovascular stent graft repair is a controversial alternative therapy. This study was performed to examine the effectiveness and mid-term outcomes of stent graft repair for AVG pseudoaneurysms. METHODS: All patients who had undergone stent graft repair for AVG pseudoaneurysms between December 2012 and July 2015 were identified from hospital medical records for retrospective analysis. Outcome measures were technical success, early and late complications, and primary and secondary patency rates. RESULTS: A total of 37 stent graft repairs of AVG pseudoaneurysms were performed in 35 patients (42.9% men; mean age 66.9 years). The mean time from AVG creation to pseudoaneurysm repair was 69 months. The indications of treatment (as per the institutional policy) were large pseudoaneurysm (56.7%), impending rupture (27.1%), and bleeding (16.2%). Mean pseudoaneurysm diameter was 23.0 mm. The most common diameter and length of stent graft used were 7 mm (67.6%) and 50 mm (48.6%), respectively. Technical success was 100%. Only one early complication occurred after stent graft repair, which was due to recurrence of the pseudoaneurysm as a result of a short landing zone. Late complications included infection (17.1%) and thrombosis (37.1%). The 1, 6, and 12 month primary patency rates were 89.2%, 55.5%, and 22.0%, respectively. The 1, 6, and 12 month secondary patency rates were 100%, 88.6%, and 78.6%, respectively. The median follow up was 12.3 months. CONCLUSIONS: The study demonstrates that endovascular stent graft repair is an effective and safe alternative therapy for AVG pseudoaneurysms. However, the rate of thrombosis and infection was high and needs to be balanced against open surgery in future studies.