Blunt traumatic superior gluteal artery pseudoaneurysm presenting as gluteal hematoma without bony injury: A rare case report

Abstract

Blunt traumatic injuries to the superior gluteal artery are rare in clinic. A majority of injuries present as aneurysms following penetrating trauma, fracture pelvis or posterior dislocation of the hip joint. We reported a rare case of superior gluteal artery pseudoaneurysm following blunt trauma presenting as large expanding right gluteal hematoma without any bony injury. The gluteal hematoma was suspected clinically, confirmed by ultrasound and the arterial injury was diagnosed by CT angiography that revealed a large right gluteal hematoma with a focal contrast leakage forming a pseudoaneurysm within the hematoma. Pseudoaneurysm arose from the superior gluteal branch of right internal iliac artery, which was successfully angioembolized. The patient was discharged on day 4 of hospitalization with resolving gluteal hematoma. This report highlighted the importance of considering an arterial injury following blunt trauma to the buttocks with subsequent painful swelling. Acknowledgment of this rare injury pattern was necessary to facilitate rapid diagnosis and appropriate treatment.

Pseudoaneurisma da artéria glútea inferior após queda de bicicleta: relato de caso

“…2,4 They may occur soon after the initial trauma or weeks, months, or years after the event. 3 Less frequently, they may be caused by blunt traumas, as described here.…”

“…4 When a person falls onto the ground or other rigid surface, suffering a blunt trauma, the inferior gluteal artery and its branches are more likely to be injured than the superior gluteal artery, because of the paths they take through the gluteal region. 1,3 Fewer than 150 cases of pseudoaneurysms of the gluteal artery have been described in the literature to date. 5 These injuries more commonly involve the superior gluteal artery and are related to penetrating traumas, iatrogenic injuries during pelvic or hip surgery, or fractures of pelvic bones, or occur after intramuscular injections.…”

“…4 The most common signs are pulsating hematoma and thrill in the gluteal region affected, which may be accompanied by local inflammation or symptoms of sciatic nerve compression. 3,4 They may present with hemorrhagic shock, when the pseudoaneurysm ruptures, and this is the most severe form of presentation. An incorrect diagnosis of a local abscess can have catastrophic consequences.…”

“…Aneurysms of the gluteal arteries are rare conditions, accounting for less than 1% of all aneurysms. [1][2][3] The superior and inferior gluteal arteries are involved more frequently, while aneurysms of the persistent sciatic artery are less common. With these arteries, pseudoaneurysms are more common than true aneurysms, and frequency is greatest in the superior gluteal artery.…”

“…1 Pseudoaneurysms of the inferior gluteal artery after blunt trauma are even rarer, with just six cases reported in the literature. 3 This article describes a case of inferior gluteal artery pseudoaneurysm after a blunt trauma (due to falling off a bicycle onto a stone, causing the blunt gluteal trauma). It illustrates the importance of considering an arterial injury in the gluteal region even after blunt trauma, in addition to describing endovascular treatment of the condition.…”