title: Progressive paralyzing sciatica revealing a pelvic pseudoaneurysm a year after hip surgery in a 12yo boy.
abstract: Identifying extra spinal causes of a lumbar radiculopathy or polyneuropathy can be a tricky diagnosis challenge, especially in children. Among them, traumatic or iatrogenic pseudoaneurysms of iliac arteries have been seldom reported, in adults' series. The authors report an unusual case of progressive paralyzing left sciatica and lumbar plexopathy in a 12 years old boy, 12 months after a pelvic osteotomy for bilateral hip luxation secondary to osteochondritis dissecans. Spine MRI and pelvic CT angiography revealed a giant internal iliac artery pseudoaneurysm, enclosed in a chronic hematoma. The patient was successfully treated with endovascular coil embolization, and subsequent surgical hematoma evacuation. However, three months after treatment, neurological recovery was incomplete. This case highlights the importance of a rapid and extensive diagnosis work up of all causes of lower limb radiculopathies in children, including pelvic arteries lesions especially after pelvic surgery to avoid therapeutic delays that may jeopardize the chances of neurological recovery.
authors.affiliation: Department of Pediatric Radiology, Necker Enfants-Malades Hospital, Paris, France. Electronic address: gregoireboulouis@gmail.com.
authors.forename: Grégoire
authors.initials: G
authors.lastname: Boulouis
authors.affiliation: Department of Pediatric Radiology, Necker Enfants-Malades Hospital, Paris, France.
authors.forename: Eimad
authors.initials: E
authors.lastname: Shotar
authors.affiliation: Department of Pediatric Radiology, Necker Enfants-Malades Hospital, Paris, France.
authors.forename: Volodia
authors.initials: V
authors.lastname: Dangouloff-Ros
authors.affiliation: Department of Pediatric Orthopedic Surgery, Necker Enfants-Malades Hospital, Paris, France.
authors.forename: Pierre-Henri
authors.initials: PH
authors.lastname: Janklevicz
authors.affiliation: Department of Pediatric Radiology, Necker Enfants-Malades Hospital, Paris, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Boddaert
authors.affiliation: Department of Pediatric Radiology, Necker Enfants-Malades Hospital, Paris, France; Department of Neuroradiology, INSERM U894, Descartes University, CH Sainte Anne, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Naggara
authors.affiliation: Department of Pediatric Radiology, Necker Enfants-Malades Hospital, Paris, France.
authors.forename: Francis
authors.initials: F
authors.lastname: Brunelle
mesh_terms: D017541:Aneurysm, False / Q000209:etiology* / Q000628:therapy; D002648:Child; D004621:Embolization, Therapeutic; D006615:Hip / Q000601:surgery; D006801:Humans; D007083:Iliac Artery / Q000473:pathology*; D008161:Lumbosacral Region; D008279:Magnetic Resonance Imaging; D008297:Male; D010008:Osteochondritis Dissecans / Q000601:surgery; D010027:Osteotomy / Q000009:adverse effects*; D012585:Sciatica / Q000209:etiology*
keywords: Coil embolization; Hip surgery; Internal iliac artery; Paralyzing sciatica; Pseudoaneurysm