49 year old male with left thigh swelling after angiography

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Doctor's Information

Name : fatemeh
Family : mousavian
Affiliation :shahid behesthi medical sciense university,shohadaye tajrish hospital,department of radiology
Academic Degree : third year radiology resident
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : fatemeh mousavian

Case Section

Interventional Radiology

Patient's Information

Gender : Female
Age : 49

Clinical Summary

49 year old male with left thigh swelling after angiography

Imaging Findings

exravasation of contrast agent from SFA associated with an unenhanced heteroecho mass around of it in anterior of left thigh with involvement of quadriceps femoris muscle.
SFA is medially deviated and narrowed (spasm) at this region
these findings can be indicative of thrombotic pseudoaneurysm

Differential Diagnosis

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Final Diagnosis

Thrombotic Pseudoaneurysm of left SFA

Discussion (Related Text)

Femoral artery pseudoaneurysms are usually iatrogenic as the femoral artery is the vessel of choice for most endovascular arterial interventions.
Causes
•iatrogenic
◦anticoagulation therapy
◦inadequate compression following endovascular intervention
◦improper arterial puncture technique; ideally the common femoral artery should be puncture
◦inadvertent femoral artery branch puncture
◦post surgical
•intravenous drug use
•penetrating trauma
Radiographic features:
Ultrasound
Due to the turbulent forward and backward flow, a characteristic yin-yang sign may be seen on colour flow while a "to and fro" pattern may be seen with pulsed Doppler.
CT
Unenhanced CT scans may demonstrate a low-attenuation rounded structure arising from the donor artery. Intermediate or high attenuation (haemorrhage) adjacent to the pseudoaneurysm may been seen and indicates pseudoaneurysmal rupture, which may vary in attenuation dependant on being chronic or acute. The pseudoaneurysmal wall is usually smooth and well defined except in a mycotic pseudoaneurysm, where the wall can be thickened, irregular, or ill defined.
CT angiography
May demonstrate a contrast filled sac. However, the entire pseudoaneurysm however may not fill with contrast material. If a low-attenuation area remains within the pseudoaneurysm, it usually indicates partial thrombosis . A communication with a donor artery is adjacent to the pseudoaneurysm can usually be seen.
Treatment and prognosis
Treatment options include :
•surgical repair
•ultrasound guided compression
•ultrasound guided thrombin injection
•endovascular therapy: stent-graft placement
At the time of writing the success rate of thrombin injection (~89-96%) is considered to be much higher than with compression (74-78%) .

References

http://radiopaedia.org/articles/femoral-artery-pseudoaneurysm