Differential diagnosis of hematoma, pulsating hematoma and pseudoaneurysm of the femoral artery using color Doppler

Color Doppler and Duplex Doppler US were employed on 4 patients with clinically suspected pseudoaneurysms as a complication of femoral artery puncture after cardiac catheterization. Pseudoaneurysms were identified with Color Doppler US and their typical appearance was confirmed. The grey-scale findings did not allow an adequate differentiation between hematoma and pulsed hematoma without fibrous encapsulation: only Color Doppler US easily detected the track between damaged artery and blood collection and allowed a sample to be obtained for pulsed Doppler examination. Color Doppler US allowed an accurate and non-invasive diagnosis of groin masses after femoral artery catheterization.     

Acutely symptomatic benign mediastinal cysts.

Usually, cystic mediastinal masses are considered as benign. However, the size of the cyst is of importance, chiefly in a closed space such as the superior mediastinum. Rarely a dramatic symptomatology may develop though this was the case in the two patients we describe, who were admitted in the department. In the first case (a parathyroid cyst), the symptoms were due to a thrombosis of the left innominate vein, and in the second case (a thyroid cyst), the severity was dominated by a dramatic compression of the trachea and the vessels. The contribution of computed tomography is nowadays undisputed. It enables the diagnosis of the cystic nature before surgery. The diagnosis can easily be confirmed by percutaneous drainage.     

Traumatic pulmonary artery pseudoaneurysm

Traumatic pulmonary artery pseudoaneurysm is an uncommon cause of a solitary nodule on a chest radiograph. Consideration of this abnormality is important as the lesion can cause fatal hemorrhage. We report a patient with a traumatic segmental pulmonary artery pseudoaneurysm detected by computed tomography and confirmed by intravenous digital subtraction angiography.     

Unsuspected mediastinal hematoma diagnosed by computed tomography

A hemophiliac (factor VIII deficiency) was admitted with falling hematocrit after upper gastrointestinal bleeding. Computed tomography diagnosed a previously unsuspected large mediastinal hematoma. The use of CT in evaluating occult bleeding is discussed.     

Eagle syndrome presenting with external carotid artery pseudoaneurysm

Eagle syndrome refers to a clinical syndrome caused by the abnormal elongation of the styloid process with calcification/ossification of the stylohyoid ligament. We present the first reported case of Eagle syndrome resulting in an external carotid artery (ECA) pseudoaneurysm. A patient presented to emergency room with an expanding, painful right-neck mass. CT angiography with three-dimensional volume rendering showed a bilobed 4.0-cm right ECA pseudoaneurysm and bilateral ossification of the stylohyoid ligaments with a sharpened edge of the right styloid process at the level of the carotid artery. Aneurysmectomy was performed, and a common carotid to internal carotid bypass with reversed saphenous vein restored arterial continuity. Local resection of the styloid process with a rotational sternocleidomastoid flap was performed. The pathology report was consistent with a diagnosis of a pseudoaneurysm. A six-month clinical follow-up confirmed the complete resolution of symptoms with no neurological deficits.     

Pediatric cystic artery pseudoaneurysm embolization

Cystic artery pseudoaneurysm is an exceedingly rare complication of biliary interventions, such as cholecystectomy, or cholecystitis [1]. Prompt intervention is often required due to their predisposition to bleeding. Ideal diagnosis and treatment would have the patient go directly to Interventional Radiology for angiography and embolization, followed by a short interval cholecystectomy [2, 3]. However, due to their low incidence patients often undergo several less invasive diagnostic tests prior to diagnosis [4]. Here we describe what we believe is the first reported pediatric case of a cystic artery pseudoaneurysm secondary to cholecystitis.     

Tuberculous pseudoaneurysm of gastroduodenal artery

We report a patient with Gastroduodenal artery (GDA) pseudoaneurysm of tuberculous aetiology, who presented with massive hematemesis and who was successfully managed with transarterial steel coil embolization. Pseudoaneurysms are a rare but potentially fatal complication of tuberculosis and hence early recognition and management of this complication is important. To the best of our knowledge this is the first report of a GDA pseudoaneurysm resulting from tuberculosis.     

Renal artery pseudoaneurysm following partial nephrectomy treated with stent-graft

Haemorrhagic complications due to pseudoaneurysms of branch arteries can be treated by selective embolisation. Injuries to the main renal artery cannot be treated in this way without sacrificing the kidney. We report the successful percutaneous treatment of a main renal artery pseudoaneurysm with a stent-graft in a patient with a solitary kidney.     

Lumbar artery pseudoaneurysm: CT demonstration

A psoas mass in a patient with a history of penetrating trauma to the area was demonstrated by computed tomography (CT) to represent a lumbar artery pseudoaneurysm surrounded by hematoma. This report emphasizes the importance of recognizing the anatomic position of the lumbar arteries on CT images and considering the possibility of pseudoaneurysm in the differential diagnosis of post-traumatic psoas masses.     

Periaortic hematoma at diaphragmatic crura at helical CT: sign of blunt aortic injury in patients with mediastinal hematoma

PURPOSE: To evaluate periaortic hematoma (PH) near the level of the diaphragm at abdominal computed tomography (CT) as an indirect sign of acute traumatic aortic injury after blunt trauma in patients with mediastinal hematoma. MATERIALS AND METHODS: From 1998 to 2001, 97 patients with CT evidence of mediastinal hematoma after blunt thoracic trauma were retrospectively identified at two level 1 trauma centers. The presence or absence of PH near the level of the diaphragmatic crura was retrospectively established by a blinded reviewer at each institution. Aortic injury status was determined by reviewing angiographic, surgical, and clinical records. Sensitivity, specificity, positive and negative productive values, and positive and negative likelihood ratios were calculated. RESULTS: Among the 97 patients with mediastinal hematoma, 14 had both PH near the level of the diaphragm and aortic injury; six had aortic injuries without PH, five had PH near the level of the diaphragm without aortic injury, and 72 had no evidence of PH near the diaphragm and no aortic injury. Sensitivity for PH near the level of the diaphragm as a sign of aortic injury was 70%; specificity, 94%; positive predictive value, 74%; and negative predictive value, 92%. The positive likelihood ratio for the presence of aortic injury was 10.8, and the negative likelihood ratio was 0.3. CONCLUSION: PH near the level of the diaphragmatic crura is an insensitive but relatively specific sign for aortic injury after blunt trauma. The presence of this sign at abdominal CT should prompt imaging of the thoracic aorta to evaluate potential thoracic aortic injury.     

Hepatic artery pseudoaneurysm in von Willebrand's disease

We report a case of hepatic artery pseudoaneurysm which occurred in a patient with von Willebrand's disease. The patient presented with upper abdominal pain and diagnosis was made by US and CT examinations. This case emphasizes the possible association between an established coagulation disorder and pseudoaneurysm. The patient was successfully treated by coil embolization.     

Posttraumatic pseudoaneurysm of the posterior cerebral artery

We present the case of a traumatic posterior cerebral artery pseudoaneurysm of a 29-year-old man due to a penetrating stab wound to the brain. The patient was brought to the emergency room in coma. The neurological examination revealed a Glasgow Coma Scale Score of 8 and left hemiplegy. The initial CT scan showed right temporal lobe haemorrhage with penetration in the lateral ventricle and subarachnoid haemorrhage. The cerebral angiography performed after three weeks, revealed a high PCA pseudoaneurysm. After surgery, a pseudoaneurysm was demonstrated in the histological study.