False aneurysm of the radial artery

Case contributed by Dr Mark Hall

Presentation

A 60 year old smoker presented to A&E 12 days ago with an acute exacerbation of COPD. Following admission to the high dependency unit for BiPAP he developed an ovoid soft tissue mass overlying the volar and radial aspect of his right wrist at the site of previous arterial cannulation. The ultrasound request read "Soft tissue mass ? collection"

Patient Data

Age: 60
Gender: Male
Photo

Right radial wrist mass

Erythematous swelling overlying the volar radius.

Ultrasound

Ultrasound of the radial aspect of the wrist was performed.  On examination there was an erythematous mass overlying the distal radius on the volar aspect of the wrist.

Ultrasound demonstrated that this mass was a radial artery aneurysm measuring 14 mm in length with a diameter of 6mm (Normal size 2mm).  The aneurysm had a broadneck and was partially thrombosed.  Doppler signal showed the classic "Yin and Yang" flow.  Thrombus is seen extending proximally up the radial artery.

Wide necked radial artery aneurysm.  

Note the narrow ulnar artery.  This is important regarding surgical planning and collateral perfusion.

Case Discussion

This case demonstrates a radial artery aneurysm following multiple attempts at radial arterial line insertion in medical HDU.  Given the traumatic nature it was felt that this was almost certainly a false aneurysm although several features such as the wide neck and thrombus within are more in keeping with a true aneurysm. 

The standard initial treatment for small peripheral arterial false aneurysms is ultrasound guided thrombin injection however, given the wide neck and overlying erythema/cellulitis it was treated surgically by tying off the vessel as the risk of graft infection and peripheral embolisation was deemed too great. In theatre the radial artery was clipped for 10 minutes before tying off to ensure that perfusion by the ulnar artery was adequate.  

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Case information

rID: 33699
Case created: 21st Jan 2015
Last edited: 29th Nov 2015
Inclusion in quiz mode: Included

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