Mistaken Identity of Popliteal Artery Pseudoaneurysm for Deep Vein Thrombosis: a Case Report

Abstract

Popliteal artery aneurysms are often incorrectly diagnosed and subsequently mismanaged with resultant preventable complications. We present a case of a swollen lower extremity clinically resembling a deep vein thrombosis (DVT), following tibial fracture fixation. It was treated as a DVT on the basis of ultrasound imaging at a different hospital. Subsequent imaging showed a popliteal artery pseudoaneurysm for which the patient required 'acute' surgical intervention. DVTs and popliteal artery aneurysms and pseudoaneurysms may coexist. We stress the importance of searching for them in patients with suspected DVT, despite an ultrasound scan (USS) which is negative or positive for thrombosis.

Mycotic pseudoaneurysm by vancomycin-intermediateStaphylococcus aureus: a rare cause of persistent bacteraemia

“…Pseudoaneurysms are aetiologically classified as iatrogenic, traumatic, anastomotic or infected, with arterial catheterisation contributing to the largest incidence 2 3. The term mycotic aneurysm was first used by Sir William Osler in 1885 to describe a ‘fresh fungal vegetation’ and has since been used to describe infected non-syphilitic arterial aneurysms and pseudoaneurysms, not necessarily fungal 4 5.…”

“…Most cases of MPA are associated with a pulsatile swelling, and can be accompanied by signs of distal ischaemia 7. Delayed diagnosis is associated with higher mortality and morbidity with complications such as distal ischaemia, acute haemorrhage, nerve palsy and rarely super-infection 3 8. They present a significant diagnostic challenge, especially if present in a setting not associated with recent arterial manipulation.…”

“…They present a significant diagnostic challenge, especially if present in a setting not associated with recent arterial manipulation. They are frequently misdiagnosed as DVTs, thereby placing the patient at a high risk of rupture and haemorrhage 3 6…”

“…S. aureus is the most commonly reported pathogen, forming nearly 28% of all MPAs 4 9. Imaging modalities employed frequently involve ultrasound with venous and/or arterial Doppler, CT scan, MRI and arteriogram 3 7 10 11. Ultrasound with/without Doppler might not accurately define pathology and vessel compromise.…”

“…Ultrasound with/without Doppler might not accurately define pathology and vessel compromise. Ultrasound requires visualisation of a neck or a hole feeding the false aneurysm, which requires operator expertise 2 3. Improper use can result in a misdiagnosis and catastrophic haemorrhage from subsequent anticoagulation for suspected DVT 1.…”