Inferior epigastric artery pseudoaneurysm following abdominal paracentesis in a patient with chronic kidney failure: A case report and review of literature

Inferior epigastric artery (IEA) pseudoaneurysm is a rare complication following abdominal wall procedures near the artery. This is a case of inferior epigastric artery pseudoaneurysm after therapeutic paracentesis for large‐volume ascites caused by chronic kidney failure. The patient was operated on, and the artery was ligated.     

Sonographic diagnosis of a pseudoaneurysm in an intravenous drug abuser

We report a case of a traumatic pseudoaneurysm and arteriovenous fistula in the groin of a drug abuser. Gray-scale and Doppler sonography were used to establish the diagnosis. Gray-scale sonography revealed an anechoic, ovoid, 7 x 4 cm mass posterior to the right superficial femoral artery, which was displaced anteriorly, with limited visualization of the deep femoral artery. Power Doppler sonography showed complete color filling of the mass, and turbulence was seen on conventional color Doppler sonography. The turbulence was confirmed with pulsed Doppler sonography of the mass. Pulsed Doppler imaging of the right external iliac vein also showed an arterialized spectral flow pattern.     

彩超对医源性股动脉假性动脉瘤及动静脉瘘的诊断

目的探讨彩超对医源性股动脉的假性动脉瘤及动静脉瘘的诊断价值。方法心导管术后出现右腹股沟搏动性包块或异常血管杂音的12例患者行彩超检查。结果12例患者中，8例诊断为假性动脉瘤，4例诊断为动静脉瘘。结论彩超能明确诊断心导管术后发生的假性动脉瘤及动静脉瘘，可作为首选的检查方法。     

MRI and ultrasonographic imaging of a patient with carotidynia

A patient presented with a painful, pulsating nodosity with marked tenderness on the right side of her neck. Cervical magnetic resonance imaging (MRI) exhibited pathological signal changes in the perivascular tissue of the carotid bifurcation area and around the external carotid artery. Similarly, Doppler sonography revealed an echo-poor wall change with outward bulging and slight narrowing of the affected vessel lumen. The clinical symptoms and our findings led to the diagnosis of carotidynia. We proposed that cervical MRI and Doppler sonography could be used for diagnosing carotidynia.     

Treatment of a radial artery pseudoaneurysm with ultrasound-guided percutaneous thrombin injection in a patient with Behçet's syndrome

A 57‐year‐old man with Behçet's syndrome and recurrent deep vein thrombosis of the lower limbs presented with a painful, pulsating mass on the volar aspect of the radial edge of his left wrist. One month before this visit, he had had venous blood drawn from the same site. Using color Doppler sonography, we diagnosed an iatrogenic pseudoaneurysm of the left radial artery, which was then treated with an ultrasound‐guided percutaneous injection of thrombin. A follow‐up examination 6 months after the treatment revealed complete resolution of the pseudoaneurysm. To our knowledge, this is the first case report to demonstrate the use of this technique for thrombosis of a pseudoaneurysm in a patient with Behçet's syndrome. We believe that the safety, efficiency, speed, and minimal invasiveness of this procedure make it feasible for use as a treatment for peripheral pseudoaneurysms in such patients. © 2003 Wiley Periodicals, Inc. J Clin Ultrasound 31:440–444, 2003     

Prenatal diagnosis of vertebral deformities associated with pentalogy of Cantrell: The role of three‐dimensional sonography?

Pentalogy of Cantrell was diagnosed in a fetus at 14 weeks of gestation, on routine two‐dimensional sonographic examination with Doppler imaging, which revealed a midline supraumbilical abdominal wall defect including herniated liver, an ectopia cordis without intracardiac anomalies, and a large omphalocele containing intestines. Although left unilateral club foot deformity was also detected as an associated anomaly in the same examination, severe lumbar lordoscoliosis was only detected by using three‐dimensional sonography because of the spatial configuration of the deformity. After termination of the pregnancy, postnatal inspection of the fetus confirmed the diagnosis of pentalogy of Cantrell associated with skeletal deformities and revealed low implant ears as an additional finding. Although two‐dimensional sonography with Doppler imaging is sufficient to diagnose pentalogy of Cantrell, it may fail to show the complex vertebral deformities and three‐dimensional sonography may assist in visualizing the defect accurately. © 2010 Wiley Periodicals, Inc. J Clin Ultrasound 38:446–449, 2010     

Popliteal artery pseudoaneurysm: a rare complication of brucellosis

Brucellosis is still a public health problem, particularly in developing countries. After the primary infection subsides, a chronic stage characterized by nonspecific manifestations can develop, during which it may not be possible to isolate Brucella organisms and agglutination test titers may or may not be high. We present the case of a 49-year-old man who had only nonspecific symptoms and a 2-month history of a pulsatile painful swelling in his right popliteal region. He had no history of trauma or surgery in that region, but he did ingest unpasteurized milk products. The patient's agglutination test titers were high, and Brucella melitensis was isolated from a bone marrow culture. Color Doppler sonography, T2-weighted MRI, and digital subtraction angiography were performed. Treatment with ultrasound-guided compression of the pseudoaneurysm failed because of high blood flow in its neck. Aneurysmectomy was undertaken, and the excised material was consistent with that from a mycotic pseudoaneurysm. Although both MRI and angiography provided useful information, the color Doppler sonography findings were characteristic of a pseudoaneurysm in the popliteal artery, and only that modality could detect the flow dynamics within the pseudoaneurysm.     

高频超声观察腹直肌内动脉对转移肌皮瓣手术的价值

目的探讨术前运用高分辨率彩色多普勒血流显像技术(CDFI)检测腹壁上、下血管对腹直肌肌皮瓣覆盖胸壁放射性溃疡的价值。方法16例乳癌放疗术后胸壁放射性溃疡患者行胸部溃疡切除、腹直肌肌皮瓣转移术。术前用以CDFI扫查双侧腹壁上、下动脉位置、走行,以二维超声检测双侧腹壁上、下动脉的管腔内径,同时以脉冲多普勒分段测血管收缩最大血流速度。结果16例32根腹壁上、下动脉均成功检测,腹壁上动脉均存在不同程度的损伤,血管出现走行变异、管腔变窄等表现,并为手术证实。结论术前使用彩色超声血管检查仪对腹壁上、下动脉主干及其肌皮穿支检测,有利于筛选手术适应症和选择肌皮瓣的血供类型,同时可指导肌皮瓣设计和确定术中腹直肌前鞘切开游离部位。     

创伤性假性动脉瘤的影像诊断及介入治疗

目的：研究创伤性假性动脉的影象学表现和介入治疗的作用。方法：分析16例创伤性假性动脉手术前CT、MRI、多普勒超声波及动脉造影表现，其中14例手术及病理证实。5例无法手术者行径导管出血动脉弹簧圈栓塞术。结果：假性动脉瘤的影像学特征性表现分别是；多普勒超声显示软组织肿块内动脉性血流、MRI上表现为流空、CT和动脉造影上则示为造影剂外溢。5例无法一期手术者行径导管出血动脉弹簧圈栓塞术，其中4例术后7－10d转行二期血肿清除术，1例胃十二指甩动脉假性动脉瘤经弹簧圈栓塞后无需手术治疗。结论：假性动脉瘤在CT、MRI、多普勒超声波及动脉造影（DSA）影像学检查上具有特征性表现。经导管动脉栓塞术对某些不宜手术的假性动脉瘤治疗不失为一种良好的选择。     

Paraumbilical venous collateral circulations: Color Doppler ultrasound features

Using Color Doppler ultrasonography to trace the dilated paraumbilical vein to its connection with systemic veins in 27 patients, we have found four major pathways: In type 1 (63%), the vein connected with the external iliac vein via the inferior epigastric vein. In type 2 (3.7%), the vein connected with the saphenous vein via the superficial epigastric vein. In type 3 (22.2%), the vein connected with the internal thoracic vein via the superior epigastric vein. Type 4 (11.1%) is a combination of types 1 and 2. A frank caput medusa was not seen, but occult caput medusae were seen in two patients. Turbulent flow was seen at the junction between inferior epigastric and external iliac veins, paraumbilical and superficial epigastric veins, and superficial epigastric and saphenous veins in some patients. Color Doppler ultrasonography is a convenient, noninvasive method for determining the course and associated hemodynamic changes in the paraumbilical collateral circulation. © 1996 John Wiley & Sons, Inc.     

Pseudoaneurysm of the gastroduodenal artery ruptured into the superior mesenteric vein in a patient with chronic pancreatitis

We report the case of a patient with chronic pancreatitis that was complicated by the rare occurrence of a pseudoaneurysm of the gastroduodenal artery that ruptured into the superior mesenteric vein. The patient, a 65-year-old alcoholic man, suddenly experienced hematemesis. Gastroesophagoscopy revealed bleeding from esophageal varices; the hemorrhaging was controlled with sclerotherapy. Sonography identified a 2-cm round anechoic mass at the pancreatic head, and color Doppler imaging revealed turbulent arterial flow within the mass, leading us to the diagnosis of the pseudoaneurysm. CT and angiographic findings generally corresponded with those of sonography and confirmed our diagnosis. The pseudoaneurysm was treated successfully with embolization, and the patient was discharged 10 days after therapy. Follow-up sonography performed 2 months later confirmed the absence of blood flow within the lesion. Color Doppler sonography was very useful for diagnosing the pseudoaneurysm and planning its treatment, and we recommend its routine use in patients with chronic pancreatitis to avoid delays in diagnosing and treating such vascular complications.     

Pseudoaneurysm of the dorsalis pedis artery: color Doppler sonographic and angiographic findings

Pseudoaneurysm of the dorsalis pedis artery is an uncommon condition that is usually caused by a traumatic injury or an iatrogenic intervention. The patient usually complains of an enlarging painless, pulsatile mass. A tentative diagnosis may be made by palpation of the pulsatile mass and detection of an associated systolic bruit. Color Doppler sonographic and arteriographic examinations can be used to confirm the diagnosis. We report the case of a 17-year-old patient with a posttraumatic pseudoaneurysm of the dorsalis pedis artery. Sonographic examinations revealed pulsatile flow into and out of a cystic structure surrounded by a thick hypoechoic wall and a "to-and-fro" pattern in the neck of the vascular mass; these findings were consistent with the diagnosis of a pseudoaneurysm. Angiography confirmed the diagnosis. The patient was treated with ligation of the artery and resection of the pseudoaneurysm. He recovered well after surgery and remained free of symptoms 3 months postoperatively. We believe that color Doppler sonography should be the procedure of choice for use in diagnosing pseudoaneurysms; arteriography can then be used to evaluate the alternative blood supply before surgery is undertaken.     

高频超声在腹直肌肌皮瓣转移修复胸壁放射性溃疡中的应用价值

目的探讨术前运用高分辨率彩色多普勒血流成像技术（CDFI）检测腹壁上、下血管对腹直肌肌皮瓣覆盖胸壁放射性溃疡的价值。方法16例乳癌放疗术后胸壁放射性溃疡患者行胸部溃疡切除、腹直肌肌皮瓣转移术。术前用以CDFI探查双侧腹壁上、下动脉位置、走行，以二维超声检测双侧腹壁上、下动脉的管腔内径，同时以脉冲多普勒分段测血管收缩最大血流速度。结果16例32根腹壁上、下动脉均成功检测，腹壁上动脉均存在不同程度的损伤，血管出现走行变异、管腔变窄等表现，并为手术证实。结论术前使用彩色超声血管检查仪对腹壁上、下动脉主干及其肌皮穿支检测，有利于筛选手术适应证和选择肌皮瓣的血供类型，同时可指导肌皮瓣设计和确定术中腹直肌前鞘切开游离部位。     

Giant renal angiomyolipoma with fatal hemorrhage due to a large pseudoaneurysm

We report a case of giant renal angiomyolipoma (AML) with a large pseudoaneurysm causing fatal hemorrhage. A 60-year-old woman presented with right-sided abdominal pain. Sonographic examination revealed a large hyperechoic renal mass. CT examination of the abdomen revealed a 15-cm AML of the right kidney with a large hemorrhagic area within it. Subsequent color Doppler examination revealed a 2.9-cm pseudoaneurysm arising from the upper segmental branch of the right renal artery. The patient, who was about to undergo transcatheter embolization of the pseudoaneurysm, died from cardio-respiratory arrest. The autopsy findings confirmed a large right renal AML containing a thrombosed pseudoaneurysm and a large perinephric hematoma.     

Avoidable morbidity in a patient with pseudoaneurysm of the uterine artery after cesarean section

We report the case of a 25-year-old female who presented to the emergency department with vaginal bleeding after a cesarean section. A diagnosis of pseudoaneurysm of the uterine artery was established radiologically; however, failure to consider this potentially life-threatening complication of cesarean section resulted in unnecessary morbidity. Doppler sonography and CT have been shown to be excellent tools for accurate diagnosis of uterine artery pseudoaneurysms, and selective arterial embolization remains the intervention of choice.     

Pseudoaneurysm of the abdominal aorta diagnosed by color duplex Doppler sonography.

A pseudoaneurysm of the abdominal aorta is rare, accounting for only 1% of all abdominal aneurysms. More than 1 imaging method may be needed to demonstrate an abdominal aortic pseudoaneurysm. We report a case in which the presence of continuous bidirectional flow in the neck of a pseudoaneurysm on color duplex Doppler sonography confirmed the diagnosis.     

Gastrointestinal inflammation in children: color Doppler ultrasonography.

We conducted this study to determine if color Doppler ultrasonography can identify increased vascularity associated with gastrointestinal inflammatory conditions and to determine if specific diagnoses can be established based on flow patterns. Twenty-five children with acute right lower quadrant pain and discharge diagnoses of inflammatory bowel processes were examined by color Doppler sonography, as an adjunct to routine gray-scale examinations. Final diagnoses included gastroenteritis (10 cases), Crohn's disease (five cases), neutropenic colitis (four cases), peritonitis (four cases), and Yersinia enterocolitis (two cases). The results of color Doppler sonography were considered positive for inflammation if increased vascularity was demonstrated in the bowel mucosa, muscularis layer, or adjacent tissues. A control group of 19 patients was examined. No sonographic abnormalities were identified in any patients in the control group. Diffuse, concentric wall thickening with increased blood flow centrally within the mucosa was seen in Crohn's disease (60%) and Yersinia enterocolitis (100%), whereas wall thickening with increased transmural vascularity was identified in neutropenic colitis (50%) and Crohn's disease (40%). In contrast, in peritonitis color Doppler sonography showed thickened bowel wall and hypervascularity within peripheral bowel wall or in adjacent soft tissues. No demonstrable bowel vascularity was seen in gastroenteritis. Our experience suggests that mucosal or transmural hypervascularity on color Doppler sonography can be seen with several inflammatory bowel processes, but it is nonspecific. However, color Doppler sonography may aid in differentiating primary bowel disease from extrinsic inflammatory conditions, such as peritonitis.     

彩色多普勒超声诊断腹主动脉、髂动脉假性动脉瘤

目的　探讨应用多普勒超声诊断腹主动脉、髂动脉假性动脉瘤的价值。方法　利用二维超声、彩色和频谱多普勒超声诊断腹主动脉、髂动脉假性动脉瘤 11例 ,9例超声检查结果经手术证实 ,其余病例经MRA检查证实。结果　腹主动脉、髂动脉假性动脉瘤 (横断面 )内彩色血流呈涡流 ;其瘤颈 (纵断面 )内的频谱呈“往复征”。结论　腹主动脉、髂动脉真性动脉瘤一般无突发的腹痛 ,动脉壁上无破口 ,瘤腔内“云雾”状血流回声不明显 ,以上特点有助于腹主动脉、髂动脉真性和假性动脉瘤的鉴别诊断 ;腹主动脉假性动脉瘤有时可以破入下腔静脉 ,形成腹主动脉下腔静脉瘘 ;超声诊断腹主动脉、髂动脉假性动脉瘤具有较高特异性。     

Groin hernias in adults: value of color Doppler sonography in their classification.

PURPOSE: We assessed the abilities of color Doppler and power Doppler sonography to distinguish among types of groin hernias by demonstrating the inferior epigastric artery (IEA) and its relationship with the hernia sac. METHODS: Nineteen consecutive patients (14 men and 5 women), clinically diagnosed as having groin hernias and scheduled to undergo herniorrhaphy, were prospectively enrolled in this study. Ultrasound examinations were performed preoperatively with a 6-12-MHz linear-array transducer. The IEA was identified, if possible, and its relationship to the hernia sac assessed. The sonographic diagnoses were compared with the operative findings. RESULTS: There were 15 indirect inguinal hernias, 4 direct inguinal hernias, and 1 femoral hernia; 1 patient had bilateral inguinal hernias (indirect and direct). In 18 (90%) of 20 hernia cases, the trunk segment of the IEA could be visualized. In 11 (55%) of 20 hernia cases, the origin segment of the IEA could be visualized and its relationship with the hernia sac assessed. In 9 (82%) of the 11 hernia cases, hernia types were correctly diagnosed by sonography. The overall accuracy of sonography for diagnosing the type of hernia was 45% (9 of 20 hernias). CONCLUSIONS: Color Doppler sonography can accurately differentiate types of groin hernias if the origin segment of the IEA and the hernia sac can be visualized simultaneously. However, color Doppler sonography sometimes failed to visualize this segment.     

Intrahepatic spontaneous portosystemic venous shunt: value of color and power Doppler sonography

Spontaneous portosystemic venous shunts (SPVSs) within the hepatic parenchyma are rare. Fewer than 50 cases have been reported, and most of them were diagnosed by angiography. We present a case of SPVS diagnosed by color Doppler sonography in a 5-year-old boy admitted for bleeding due to rupture of esophageal varices. Conventional color and power Doppler sonography as well as CT showed a large shunt between the posterior branch of the right portal vein and the inferior vena cava. We believe that accurate diagnosis and follow-up of SPVS can be done with color Doppler sonography without resorting to angiography.