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.

X-ray

Serial post-operative plain films

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

Pseudoaneuysms 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 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 radiation dose.

 

Procedure performed with:
Dr Konstantinos Katsanos, MSc, MD, PhD, EBIR
Consultant Interventional Radiologist

Guy's and St. Thomas' Hospitals

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Case information

rID: 37452
Published: 10th Jun 2015
Last edited: 12th Oct 2019
Inclusion in quiz mode: Included