Pseudoaneurysm formation following a traumatic wrist laceration

Abstract

Pseudoaneurysms occur secondary to partial disruption of the arterial wall. They are a commonly described complication of arterial injury, with penetrating injury and iatrogenic arterial catheterization being the most common etiologies in children. Many present weeks to months after the injury, and the initial vascular injury is often missed. The complications of pseudoaneurysm, which include thromboembolism, neurapraxia, and compartment syndrome, underscore the importance of early recognition and management. Definitive therapy consists of ultrasound-guided compression or resection and possible graft interposition. We describe a case of pseudoaneurysm formation in the radial artery of an adolescent girl 6 weeks following a penetrating injury. The patient's injury was complicated by sensory and motor deficits consistent with ulnar nerve compression. This case attests to the importance of adequately ruling out arterial injury in penetrating injury and close followup if the history is suggestive. In addition, a high index of suspicion is warranted to facilitate imaging of a pulsatile mass to avoid confusion of a thrombosed artery with an abscess. RÉ SUMÉLes pseudoané vrismes sont le ré sultat d'une rupture partielle de la paroi arté rielle. C'est une complication couramment dé crite de la lé sion arté rielle, la blessure pé né trante et le cathé té risme arté riel iatrogè ne constituant les é tiologies les plus fré quentes chez les enfants. Ils se pré sentent à l'urgence des semaines, voire des mois aprè s le traumatisme, et la blessure vasculaire initiale n'est souvent pas repé ré e. Les complications du pseudoané vrisme, dont la thromboembolie, la neurapraxie, et le syndrome des loges, soulignent l'importance du dé pistage et de sa prise en charge pré coces. La compression é choguidé e ou la ré section et possiblement l'interposition d'une greffe repré sentent le traitement dé finitif. Nous dé crivons un cas de pseudoané vrisme dans l'artè re radiale d'une adolescente 6 semaines aprè s une blessure pé né trante. La blessure de la patiente a é té aggravé e par des dé ficits sensoriels et moteurs compatibles avec une compression du nerf cubital. Ce cas dé montre l'importance d'exclure la lé sion arté rielle en cas de blessure pé né trante et de faire un suivi é troit en pré sence d'anté cé dents é vocateurs. En outre, un haut degré de suspicion est justifié pour faciliter l'imagerie d'une masse pulsatile afin d'é viter toute confusion entre une artè re thrombosé e et un abcè s.

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

“…The history of a previous trauma makes it suspicious for hematoma or an abscess. Erythema, pain or local paresthesia may be other complains [13]. The physician should examine the patient carefully with digital examination, because pulsatility is an important clinical finding suggestive of pseudoaneurism.…”

“…They occur later with unknown mechanism, and present even months to years after the initial injury [20]- [13]- [1]. Posttraumatic pseudoaneurysms happen in every damaged artery after trauma, although femoral and radial arteries are the most common vessels.…”

“…The most common causes of radial pseudo aneurysm in children are penetrating trauma and iatrogenic arterial injuries [13], [1]. The children with penetrating injuries of sharp cuts are more prone to pseudoaneurisms [4].…”

“…The time of presentation, does'nt correlate exactly with the time of the injury. Sometimes, patients are admitted to hospitals with pseudoaneurysms weeks, months or even years after the trauma [4], [13].…”

“…Pseudoaneurysms are a rare complication of radial arterial injury especially in children [4]- [21]- [13].The arterial lesions are not detected usually at the time of injury and present later with pain and swelling at the site of the original injury.…”