Case 12 - She's gonna blow...
Author: Nish Cherian Reviewer: Nick Mani
A 70-year old male presents to ED with a swelling in the right wrist following an angiogram 1 week prior. It had increased in size over the course of a few days and mildly painful. On examination, it is a well circumscribed pulsatile lump (approx 2x2cm) over the volar aspect of the right wrist with bruising and tenderness.
The lump is interrogated further with POCUS:
Clip 1. Short axis R wrist
Clip 2. Short axis R wrist - scanning from distal to proximal
Clip 3. Short axis with colour flow
Clip 4. Long axis with colour flow
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Radial artery pseudoaneurysm.
This is a rare complication of radial artery/cardiac catheterisation and carries a high risk of rupture at this size.
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“Yin-yang sign” showing bi-directional colour flow due to swirling of blood within the pseudoaneurysm
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The neck of the pseudoaneurysm is shown - this is the point of weakness in the artery wall from where it bulges out forming the pseudoaneurysm.
Case resolution
The patient was referred to the Vascular service for further management - the POCUS findings facilitated a prompt evaluation by the Vascular surgeon overnight. The patient failed a period of conservative management with compression bandaging so underwent artery ligation under local anaesthesia in theatre.
