Pseuodaneurysm of left femoral profunda femoris post dynamic hip screw insertion

Case contributed by Dr Nolan Walker

Presentation

Persistent left thigh pain post left dynamic hip screw requiring regular dihydrocodeine to control.

Patient Data

Age: 75 years
Gender: Male

Post-op x-ray reveals subtle soft tissue swelling at the medial aspect of the left thigh.

X-ray post dynamic hip screw taken 2 months post procedure reveals soft tissue swelling and displacement of calcified left SFA. Early medial femoral cortical thinning is present.

Serial post-operative plain films

X-ray

Plain film taken 5 months post-operatively. Soft tissue swelling on the medial aspect of the left thigh with scalloping of the medial cortex of the proximal femur.

CTA study performed 5 months post-operatively revealed soft pseudoaneurysm of left profunda branch. Artifact from the left dynamic hip screw.

Selective left femoral artery DSA reveals pseudo aneurysm of left profunda branch.
Successful coiling of left profunda femoris pseudo-aneurysm, post procedure angiogram revealed no flow in the aneurysm. Good result obtained.

Case Discussion

Pseudoaneurysms have been reported in the literature post-DHS.

In this case, the patient presented with persistent thigh pain. The findings are visible on the plain film, although subtle initially.

Review of the soft tissues in the postoperative X-ray in conjunction with an awareness of this complication can help the radiologist make an early diagnosis.

Ultrasound could be used if there is a suspicion of pseudoaneurysm in order to decrease the radiation dose.

Procedure performed with:
Dr Konstantinos Katsanos, MSc, MD, PhD, EBIR
Consultant Interventional Radiologist
Guy's and St. Thomas' Hospitals

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.