Uncommon incidental pseudoaneurysm. Diagnostic and management challenges.
OBJECTIVE
To analyze patients with uncommon incidental pseudoaneurysms, secondary to non-catheterization causes, and to discuss the peculiar clinical spectrum, and focus on some aspects of difference from post-catheterization pseudoaneurysms.


METHODS
Eleven patients, 8 males and 3 females, were studied retrospectively in Jordan University Hospital, Amman, Jordan, between 2002-2008. Radiological studies performed included duplex sonography (DS), computed tomography (CT), conventional angiography, magnetic resonance imaging (MRI), and magnetic resonance angiography (MRA).


RESULTS
Pseudoaneurysms were most commonly encountered in young males (63.6%), especially in the lower limb vessels (36%). Clinical findings were suggestive of pseudoaneurysms in 27% of our cases. Four out of the 8 DS scans showed the neck of pseudoaneurysms, and the to and fro waveform, the strongest indicators for pseudoaneurysms. Both CT with intravenous contrast and angiography failed to establish the diagnosis in one out of 5 cases. The MRI with MRA showed the pseudoaneurysms in 2 patients that underwent the scan.


CONCLUSIONS
Incidental pseudoaneurysms are considered following iatrogenic procedures, penetrating, or blunt traumas with variable delay time. Young healthy males are at increased risks, as opposed to elderly females with calcified vessels in post-catheterization cases. Duplex sonography is less sensitive in incidental than post-catheterization pseudoaneurysms. The CT scan with intravenous contrast has high accuracy in establishing the diagnosis in small, or medium sized pseudoaneurysms. The MRI and MRA are accurate valuable studies and comparable to conventional angiography.
Hadidy
Azmy M
AM
Department of Diagnostic Radiology, Jordan University Hospital, University of Jordan, Amman, Jordan. amshadidy@yahoo.com
Samara
Osama A
OA
Takrouri
Heba S
HS
Al-Ryalat
Nosaiba T
NT
Al-Smady
Moaath M
MM
Ryalat
Soukaina T
ST
Abu-Khalaf
Mahmoad M
MM
D000293:Adolescent; D000328:Adult; D017541:Aneurysm, False / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D006801:Humans; D007866:Leg / Q000098:blood supply; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D016909:Tibial Arteries / Q000000981:diagnostic imaging; D018616:Ultrasonography, Doppler, Duplex; D055815:Young Adult