Endgames Case Report

A painful swelling in the groin

BMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f2185 (Published 11 April 2013) Cite this as: BMJ 2013;346:f2185
  1. John Julian Harvey, specialist registrar12,
  2. Martin J Duddy, consultant interventional radiologist 1
  1. 1Department of Diagnostic and Interventional Radiology, Queen Elizabeth Hospital Birmingham, Birmingham B15 2WB, UK
  2. 2Royal Centre for Defence Medicine, Queen Elizabeth Hospital Birmingham
  1. Correspondence to: J J Harvey julesharvey{at}gmail.com

A 76 year old woman presented with a 13 day history of severe pain and swelling in her right groin. She lived independently with her husband and normally had an active life, but walking was becoming increasingly difficult because of the groin pain. Although she denied any recent trauma, she had been treated for an incidentally discovered cerebral artery aneurysm three weeks earlier. The treatment had been successful and she said it had been performed using a “special needle in my groin.” She had been discharged from hospital one week after the procedure and had not had fever or discharge from the groin puncture wound. She was otherwise in good health. Her current drugs were aspirin and clopidogrel, which she took for ischaemic heart disease.

On clinical examination she had a small, pulsatile, exquisitely tender mass in the proximal medial right thigh, just distal to the right groin skin crease. The healed needle puncture site was close to the mass. Distal pulses in the right lower limb were strong, and the limb was warm with no skin changes or visible bruising. A clinical diagnosis of iatrogenic right femoral artery pseudoaneurysm was made. A Doppler ultrasound of the right femoral artery was requested to confirm the diagnosis and guide further management.

The Doppler ultrasound confirmed the presence of a large (4×3 cm) rounded sac superficial to the distal right common femoral artery. The sac was directly connected to the artery by a narrow neck and a high velocity jet of arterial blood was seen flowing into the sac, consistent with a pseudoaneurysm of the right common femoral artery.

Questions

  • 1 What is the difference between a true aneurysm and a pseudoaneurysm?

  • 2 Are pseudoaneurysms common after percutaneous vascular intervention? …

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