posttraumatisches Aneurysma spurium

Aneurysma

spurium der A. profunda femoris links nach komplexer Revisionsoperation einer Hüftendoprothese. Links Computertomographie: Das kleine Feeder-Gefäß (Pfeil) ließ sich nach oben als Ast der A. profuna femoris identifizieren. Man sieht neben dem lokalen kontrastierten Blutaustritt eine große Einblutung vor allem in die ischiocrurale Muskulatur. Rechts primäre Darstellung in der DSA nach Cross-over-Sondierung: Der Kontrastmittelaustritt ist vom Prothesenschaft partiell überdeckt.

Wikipedia • CC BY-SA 3.0

Aneurysma

spurium der A. profunda femoris links nach komplexer Revisionsoperation einer Hüftendoprothese. Nach Drehung des C-Bogens konnten die Blutung und das Feeder-Gefäß frei dargestellt und mit Coils embolisiert werden. Dabei wurde ein erster 3 mm Coil beim Versuch der Platzierung unmittelbar an der Leckagestelle in die Blutungshöhle abgeschwemmt. Nach weitereren 4 mm Coils dann komplettes Sistieren der Blutung.

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posttraumatisches Aneurysma spurium

Aneurysma spurium Radiopaedia • CC-by-nc-sa 3.0 • de

False aneurysms, also known as pseudoaneurysms, are abnormal outpouchings or dilatation of arteries which are bounded only by the tunica adventitia, the outermost layer of the arterial wall. These are distinguished from true aneurysms, which are bounded by all three layers of the arterial wall. Pseudoaneurysms typically occur when there is a breach in the vessel wall such that blood leaks through the inner wall but is contained by the adventitia or surrounding perivascular soft tissue.

Pathology

Etiology

trauma (dissection or laceration)
iatrogenic (dissection, laceration or puncture)
- arterial catheterization - accounts for most iatrogenic pseudoaneurysms
- biopsy, surgery
spontaneous dissection
fibromuscular dysplasia (dissection)
mycotic aneurysm (inflammatory digestion of the vessel wall)
myocardial infarction (left ventricular false aneurysm)
regional inflammatory process
- acute pancreatitis
- chronic pancreatitis
vessel injury/erosion due to a tumor: relatively uncommon
vasculitides
penetrating atherosclerotic ulcer

Location

They can involve any arterial segment or even a cardiac chamber. Examples include

aortic pseudoaneurysm: traumatic aortic pseudoaneurysm
femoral artery pseudoaneurysm: relatively common site due to femoral punctures
carotid artery pseudoaneurysm
visceral arterial pseudoaneurysm
- hepatic arterial pseudoaneurysm
- gastroduodenal arterial pseudoaneurysm
- splenic arterial pseudoaneurysm
- peri-pancreatic pseudoaneurysm
- renal arterial pseudoaneurysm
peripheral arterial (limb) pseudoaneurysm
left ventricular pseudoaneurysm
brachiocephalic artery pseudoaneurysm

Radiographic features

Some of the imaging features may be dependent on location.

Ultrasound

Due to the turbulent forward and backward flow, a characteristic yin-yang sign may be seen on color flow while a "to and fro" pattern may be seen with pulsed Doppler.

CT

hypoattenuating (non-contrast) or hyperattenuating (contrast-enhanced) smooth-walled sac adjacent to an artery, usually with a communication

Treatment and prognosis

The risk of rupture is higher than that of a true aneurysm of comparable size due to poor support of the aneurysm wall and thus false aneurysms generally require treatment.