Finding the Balance: The Point-of-Care Ultrasound Diagnosis of Pseudoaneurysm

• Published in: The Journal of emergency medicine Vol. 66; no. 6; pp. e723 - e724
• Main Authors: Habiyaremye, Terrence D., Alloy, Alyssa C., Gibbons, Ryan C.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2024
• Subjects: Aneurysm, False - diagnostic imaging; Brachial Artery - diagnostic imaging; Brachial Artery - injuries; Emergency Service, Hospital - organization & administration; Humans; Male; Middle Aged; Point-of-Care Systems; Ultrasonography - methods
• ISSN: 0736-4679; 2352-5029
• DOI: 10.1016/j.jemermed.2024.01.011

A 49-year-old male with history of intravenous drug use presented to the Emergency Department with localized right arm swelling that has been slowly growing for months. On physical exam, there was a golf ball sized mass in the right antecubital fossa without overlying skin changes and no neurovascular deficits in the distal extremity. Point-of-care ultrasound (POCUS) was performed utilizing a water bath with visualization of bidirectional swirling in a round cavity adjacent to the brachial artery. Aneurysms are abnormal focal dilations that result from vascular wall defects. Ultrasound has been reported to have 94% sensitivity and 97% specificity for diagnosis of pseudoaneurysms. On color doppler ultrasound, pseudoaneurysm is characterized by the pathognomonic “yin-yang” sign. In the case of the 49-year-old male with a right antecubital mass and history of IVDU, the proposed mechanism of injury was trauma to the arterial wall secondary to auto-injection. POCUS has been found to improve identification of abscesses and its incorporation in patient evaluation can guide clinical management, prevent unwanted iatrogenic exsanguination, and determine whether there is a need for urgent vascular surgery intervention, particularly in high-risk patients.