Annals of Emergency Medicine
Volume 51, Issue 3 , Page 330, March 2008

Images in Emergency Medicine

  • James F. Holmes, MD, MPH

      Affiliations

    • Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, CA
  • ,
  • Daniel P. Link, MD

      Affiliations

    • Department of Radiology, UC Davis School of Medicine, Sacramento, CA
  • ,
  • Lynette Scherer, MD

      Affiliations

    • Department of Surgery, UC Davis School of Medicine, Sacramento, CA.
  • ,
  • Aaron E. Bair, MD

      Affiliations

    • Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, CA

Article Outline

 

[Ann Emerg Med. 2008;51:330.]

A 32-year-old man presented to the emergency department (ED) for evaluation of continued left thigh pain and swelling. Six weeks before, the patient sustained a stab wound to the superiolateral aspect of his left thigh, and ED evaluation consisted of a normal plain radiograph and wound cleaning. Two weeks after the initial ED visit, the patient developed pain and swelling at the site and was treated by his primary care physician with 2 courses of oral antibiotics for presumed abscess.

Back to Article Outline

Diagnosis 

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.

  • View full-size image.
  • 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.

 For the diagnosis and teaching points, see page 342.

 To view the entire collection of Images in Emergency Medicine, visit www.annemergmed.com

PII: S0196-0644(07)01295-4

doi:10.1016/j.annemergmed.2007.07.006

Annals of Emergency Medicine
Volume 51, Issue 3 , Page 330, March 2008