0:00

Our next case is that of a pseudoaneurysm in the setting of

0:04

an iatrogenic trauma. So we looked at a pseudoaneurysm earlier in the

0:08

setting of an anastomosis, so they can happen at

0:12

anastomotic sites, but they can also just happen after an

0:15

access. So as we're scrolling down this run-off study,

0:20

we can see that there's an aneurysmal celiac artery here and

0:24

significant stenosis of that celiac artery here, probably due to median arcuate

0:27

ligament compression. But we're going to basically focus

0:32

on trauma-related complications on this section.

0:35

So we're going to scroll all the way down, and we can see that there's a lot of

0:38

stranding in this left inguinal region.

0:41

There is this hyperdensity here. And coming out of

0:45

this left common femoral artery

0:48

is this out-pouching arising anteriorly, and we can see that

0:52

there's this long neck that comes out

0:56

from that common femoral artery

0:59

right here.

1:01

And so this is a

1:04

contrast fill out-pouching

1:07

seen on the arterial phase, arising along the anterior aspect

1:11

of the left common femoral artery, measuring at least

1:15

13 by 10 millimeter with a long neck that

1:19

measures approximately

1:21

seven millimeter

1:24

right here.

1:26

And then if we look at the delayed scan, there's really no

1:30

change in that morphology at all, and so there's no active bleed,

1:35

but it's just a pseudoaneurysm as

1:39

opposed to the scan that we saw previously.

1:42

Another area that is typically an area of

1:46

a diagnostic pitfall, which is seen in this person, is

1:50

that this is a pseudoaneurysm, but there's another area that's kind of

1:53

bright over here. And if we look at that on the delayed

1:57

phase, one might wonder that that might also be an enhancing

2:01

structure. But in fact, looking at the morphology of these structures is

2:05

really important. This is actually just small inguinal lymph nodes.

2:08

There are many more up top here as well, more cranially.

2:12

And you can see its configuration on the non-contrast image, that these are all

2:16

lymph nodes with their fatty hilum.

2:17

So it's important to make sure we're not over-calling things,

2:22

make sure that you know that lymph nodes can sometimes mimic the

2:26

appearance

2:28

of an extravasated pseudoaneurysm,

2:31

and to always have an appropriate delayed phase

2:35

to problem-solve between a pseudoaneurysm and an

2:39

active bleed.