Images in Emergency Medicine

Profunda femoral artery pseudoaneurysm after a stab wound 

ED evaluation revealed a 20-cm area of swelling in the proximal thigh (Figure 1), thought initially to be an abscess. Further examination, however, documented a palpable pulse and audible bruit. Doppler ultrasonography revealed a large cystic structure with marked flow signal (Figure 2), consistent with pseudoaneurysm. Computed tomography (CT) angiography confirmed a large pseudoaneurysm and arteriovenous fistula arising from the left profunda femoral artery (Figure 3). Interventional radiology confirmed the injury (Figure 4) and deployed a stent graft over the site of injury. After stent deployment, there was no filling of the pseudoaneurysm (Figure 5). Through 6 weeks of follow-up, the patient recovered well, with resolution of his swelling and no further complications.

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Figure 1. Left thigh mass.

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Figure 2. Doppler ultrasonography of mass.

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Figure 3. Computed tomographic angiography of left lower extremity.

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Figure 4. Left lower extremity arteriogram.

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Figure 5. Arteriogram status post stent deployment. Used with permission of James F. Holmes, MD, MPH, Department of Emergency Medicine, University of California-Davis School of Medicine, Sacramento, CA.

Pseudoaneurysms may occur after penetrating injuries or procedures requiring arterial punctures. In this case, the patient was initially considered to have an abscess, according to the history of failing oral antibiotic treatment. In patients with swelling and erythema after penetrating trauma, pseudoaneurysm should be considered before performance of incision and drainage of a presumed abscess because such a procedure may be life threatening in the patient with a pseudoaneurysm. Radiologic studies, including Doppler ultrasonography or CT angiography, will correctly differentiate a pseudoaneurysm from an abscess. Treatments for a pseudoaneurysm are varied and depend on multiple factors.