Dublex Doppler US Diagnosis and Follow Up of a Post Traumatic Pseudoaneurysm of the Radial Artery

Abstract

Introduction: Post traumatic pseudoaneurysms of the radial artery are rare complications in children. They are seen mostly later; weeks or even months after a penetraiting trauma injury. The serious complications of radial artery pseudoaneurysm, such as spontaneous rupture, ischemia and compartment syndrome emerge early diagnosis and treatment. A high index of suspicion is needed for clinicians to avoid confusion with an abscess or hematoma. Duplex ultrasound is the first method to establish the diagnosis of a pseudoaneurism. It is now widely accepted as the the modality of choice for diagnosis of pseudoaneurism of extremities. Early detection and therapeutic intervention before the pseudoaneurysm manifests clinically with complications is very important. Timely adequate diagnosis and treatment has decrease the morbidity and mortality rates for pseudoaneurysms. As a non invasive method it is now widely used olso as a guided therapeutic option before and instead surgical treatment. Case report: In this article we present a case of a post traumatic pseudoaneurysm in the radial artery of a 12 years old girl diagnosed by dublex ultrasound. The pseudoaneurism was detected 2 weeks after a sharp injury caused by a piece of glass at the medial distal part of the right forearm. The pseudoaneurysm was unfortunately first confused as an abscess in gray scale ultrasound. Follow up dublex US for 2 weeks without treatment revealed thrombosed of the pseudoaneurism continuing with recanalisation of blood flow from radial artery to pseudoaneurism. Conclusion: Imaging with dublex color doppler resolve the diagnosis, otherwise the confusion with an abscess, as in our patient may have the disastrous consequence of incision and drainage. Duplex ultrasound is recommended as an efficiency diagnostic method for forearm and wrist swelling in children after injury. Timely adequate diagnosis and treatment has decrease the morbidity and mortality rates for pseudoaneurysms. This case remind us for careful examination and follow up of the swelling mass after trauma in children. In these cases dublex color Doppler is an imperative investigation to avoid confusion with an abscess or hematoma.