Pulsating mass after accidental artery trauma: diagnosis with duplex ultrasound and the role of angiography.
BACKGROUND
Pulsating mass located close to peripheral arteries is usually considered as a result of arterial wall injury. Clinically important is to distinct pseudoaneurysm from haematoma and also to evaluate proximal and distal arterial bed for the assessment of the injury extent. A few previous reports claim good results of duplex Doppler US diagnosis of iatrogenic (post-catheterization) femoral artery injuries. This paper presents diagnostic findings of arterial injuries caused by accidental trauma.


METHODS
A retrospective analysis of 49 patients with post-traumatic pulsating mass close to peripheral artery was performed. The diagnostic results of both sonography and angiography were reviewed. All the patients underwent B-mode and duplex Doppler US examination using PW-, color- and power Doppler imaging techniques.


RESULTS
34 pseudoaneurysms were diagnosed correctly with typical B-mode, color/power Doppler images and PW-Doppler spectral waveforms. The lack of flow signal and distinctive B-mode images enabled proper diagnosis of 13 haematomas. In 2 patients duplex Doppler US misdiagnosis occurred, because of secondary pseudoaneurysm formation, primary diagnosed as haematoma. The 47 correct US findings gave 96% efficacy in distinguishing pseudoaneurysm from haematoma, which compares well with the other studies. In 20 patients suffering from peripheral ischemia, US examination, in spite of proper distinction between pseudoaneurysm and haematoma was unable for precise estimation of proximal and distal arterial damage. Thus, it was successfully supported with angiography before surgical decision making. Angiography was also necessary in 8 patients with severe injuries of carotid, subclavian and palmar arch arteries, hardly accessible for ultrasound penetration.


CONCLUSIONS
We conclude that duplex Doppler US is essential for noninvasive, unequivocal distinction between pseudoaneurysm and haematoma but it could not completely replace contrast angiography in the evaluation of post-traumatic pulsating mass caused by severe, extensive trauma, frequently complicated with peripheral ischemia or located in regions with poor access for ultrasound penetration.
Jargiello
T
T
Department of Interventional Radiology and Neuroradiology, University School of Medicine, Lublin, Poland.
Zubilewicz
T
T
Janczarek
M
M
Szajner
M
M
Pietura
R
R
Szczerbo-Trojanowska
M
M
D000328:Adult; D017541:Aneurysm, False / Q000175:diagnosis* / Q000503:physiopathology; D000792:Angiography; D001132:Arm / Q000098:blood supply*; D001158:Arteries / Q000293:injuries / Q000503:physiopathology; D005260:Female; D006406:Hematoma / Q000175:diagnosis / Q000503:physiopathology; D006801:Humans; D007866:Leg / Q000098:blood supply*; D008297:Male; D011673:Pulsatile Flow / Q000502:physiology; D012189:Retrospective Studies; D018615:Ultrasonography, Doppler, Color; D018616:Ultrasonography, Doppler, Duplex