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Aoki R, Nakajima K, Kobayashi Y, Sakai Y, Kamide H, Yamamoto T, Furugori S, Sawamura S, Terauchi M, Kamiyama K, Ikeda S, Tsuji G, Koyama S, Yoshigi J, Sekikawa Z, Utsunomiya D. Common and uncommon vascular injuries and endovascular treatment associated with pelvic blunt trauma: a real-world experience. Jpn J Radiol 2023; 41:258-265. [PMID: 36350523 PMCID: PMC9974705 DOI: 10.1007/s11604-022-01355-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 10/20/2022] [Indexed: 11/11/2022]
Abstract
Pelvic fractures are common in cases of blunt trauma, which is strongly associated with mortality. Transcatheter arterial embolization is a fundamental treatment strategy for fatal arterial injuries caused by blunt pelvic trauma. However, vascular injuries due to blunt pelvic trauma can show various imaging findings other than arterial hemorrhage. We present a pictorial review of common and uncommon vascular injuries, including active arterial bleeding, pseudoaneurysm, arteriovenous fistula, arterial occlusion, vasospasm, and active venous bleeding. Knowledge of these vascular injuries can help clinicians select the appropriate therapeutic strategy and thus save lives.
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Affiliation(s)
- Ryo Aoki
- Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan. .,Department of Diagnostic Radiology, Yokohama City University Medical Center, Yokohama, Japan.
| | - Kento Nakajima
- grid.268441.d0000 0001 1033 6139Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yusuke Kobayashi
- grid.413045.70000 0004 0467 212XDepartment of Diagnostic Radiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Yodo Sakai
- grid.417369.e0000 0004 0641 0318Department of Diagnostic Radiology, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Hiroyuki Kamide
- grid.413045.70000 0004 0467 212XDepartment of Diagnostic Radiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Toh Yamamoto
- grid.417369.e0000 0004 0641 0318Department of Diagnostic Radiology, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Shintaro Furugori
- grid.413045.70000 0004 0467 212XAdvanced Critical Care and Emergency Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Shungo Sawamura
- grid.268441.d0000 0001 1033 6139Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Miki Terauchi
- grid.413045.70000 0004 0467 212XDepartment of Diagnostic Radiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Kazutoshi Kamiyama
- grid.268441.d0000 0001 1033 6139Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Shin Ikeda
- grid.417369.e0000 0004 0641 0318Department of Diagnostic Radiology, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Gengo Tsuji
- grid.417369.e0000 0004 0641 0318Department of Diagnostic Radiology, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Shingo Koyama
- grid.268441.d0000 0001 1033 6139Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Jun Yoshigi
- grid.417369.e0000 0004 0641 0318Department of Diagnostic Radiology, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Zenjiro Sekikawa
- grid.413045.70000 0004 0467 212XDepartment of Diagnostic Radiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Daisuke Utsunomiya
- grid.268441.d0000 0001 1033 6139Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Bilekli AB, Kılınç NS, Neyişci Ç, Erdem Y, Bek D. Delayed presentation of gluteal compartment syndrome presenting with peroneal palsy secondary to superior gluteal artery pseudoaneurysm following ballistic injury. ULUS TRAVMA ACIL CER 2022; 28:1020-1026. [PMID: 35775677 PMCID: PMC10493846 DOI: 10.14744/tjtes.2020.72066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 09/25/2020] [Indexed: 11/20/2022]
Abstract
Gluteal compartment syndrome (CS) secondary to the superior gluteal artery (SGA) injury and pseudoaneurysm formation is a very rare condition. When it does occur, it usually manifests with acute and life-threatening hemorrhage resulting in early hypov-olemic changes. Delayed presentation of the gluteal CS (GCS) after trauma has been described in the literature seldom and these cases were demonstrated with sciatic nerve palsy, hemodynamic instability, decreased hemoglobin levels, increasing buttock pain, and a large gluteal hematoma. In this report, we present a case of GCS presenting with the palsy of the peroneal division of the sciatic nerve secondary to SGA pseudoaneurysm following ballistic injury, with a delay of nearly 20 days in diagnosis and treatment with normal hemodynamic findings. The patient required emergent angiographic embolization and then fasciotomy which were approx-imately 13 days after the onset of the symptoms. The patient made a positive recovery with no further neurologic deterioration and none local wound or systemic complications. This case emphasizes the importance of early diagnosis and treatment of this rare condition.
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Affiliation(s)
- Ahmet Burak Bilekli
- Department of Orthopedics and Traumatology, Gülhane Training and Research Hospital, Ankara-Türkiye
| | - Nisa Selin Kılınç
- Department of Orthopedics and Traumatology, Gülhane Training and Research Hospital, Ankara-Türkiye
| | - Çağrı Neyişci
- Department of Orthopedics and Traumatology, Gülhane Training and Research Hospital, Ankara-Türkiye
| | - Yusuf Erdem
- Department of Orthopedics and Traumatology, Gülhane Training and Research Hospital, Ankara-Türkiye
| | - Doğan Bek
- Department of Orthopedics and Traumatology, Gülhane Training and Research Hospital, Ankara-Türkiye
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Ben Mrad I, Ben Salah R, Ben Mrad M, Miri R, Haddad A, Mleyhi S, Zairi I, Hamza K, Jrad M, Denguir R. Hybrid Management of a Pseudoaneurysm of the Inferior Gluteal Artery Following a Stab Wound. Open Access Emerg Med 2021; 13:319-323. [PMID: 34321933 PMCID: PMC8313107 DOI: 10.2147/oaem.s312083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/07/2021] [Indexed: 11/23/2022] Open
Abstract
Aneurysms and pseudoaneurysms of the gluteal artery are rare. They represent less than 1% of the described arterial aneurysms. Those that touch the inferior gluteal artery are even rarer. Only a few cases have been described worldwide. Such cases often present with a variable time course, mode of injury, and associated symptoms, leading to their misdiagnosis and improper treatment. We present the case of a 30-year-old male, who presented to our emergency room one week after a stab wound in the left gluteal region causing a pseudoaneurysm of the left inferior gluteal artery with a sciatic compartment syndrome treated by a hybrid approach.
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Affiliation(s)
| | - Ramy Ben Salah
- Plastic Surgery Department, Bizerte Hospital, Tunis, Tunisia
| | - Melek Ben Mrad
- Cardiovascular Surgery Department, Rabta Hospital, Tunis, Tunisia
| | - Rim Miri
- Cardiovascular Surgery Department, Rabta Hospital, Tunis, Tunisia
| | - Anis Haddad
- General Surgery Department, Rabta Hospital, Tunis, Tunisia
| | - Sobhi Mleyhi
- Cardiovascular Surgery Department, Rabta Hospital, Tunis, Tunisia
| | - Ihsen Zairi
- Cardiology Department, Hbib Thameur Hospital, Tunis, Tunisia
| | - Khalil Hamza
- Radiology Department, Charles Nicolle Hospital, Tunis, Tunisia
| | - Mariem Jrad
- Radiology Department, Charles Nicolle Hospital, Tunis, Tunisia
| | - Raouf Denguir
- Cardiovascular Surgery Department, Rabta Hospital, Tunis, Tunisia
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Coste M, Yoon D, Noory M, Roudnitsky V. Superior gluteal artery pseudoaneurysm after a gunshot wound to the buttock: A case. Int J Surg Case Rep 2020; 77:341-344. [PMID: 33212307 PMCID: PMC7683236 DOI: 10.1016/j.ijscr.2020.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 10/31/2020] [Accepted: 11/02/2020] [Indexed: 11/05/2022] Open
Abstract
Gunshot and stab wounds are common causes of penetrating trauma to the buttock. Penetrating trauma to the upper zone of the buttock can result in vascular injury. Pseudoaneurysms are rare complications of traumatic arterial injuries. Pseudoaneurysms can be treated with embolization. There are no guidelines for screening of gluteal pseudoaneurysms after trauma.
Introduction Penetrating trauma to the buttock can rarely result into the development of a gluteal artery pseudoaneurysm. Here we present the case of a patient with a superior gluteal pseudoaneurysm after a gunshot wound to the left buttock. Presentation of case A 48-year-old male presented with fullness and tenderness at the left gluteal wound that resulted from a gunshot 18 days prior. At the time of initial trauma, imaging showed minimal extravasation of contrast at the left superior gluteal artery, but the bleeding stopped and patient was discharged. On his return, examination showed palpable fluctuance but no bleeding. A superior gluteal artery pseudoaneurysm was identified on CT scan. Patient also complained of intermittent subjective fever and new onset of SOB. CT chest demonstrated a pulmonary embolism at the right basilar segmental artery. Coil embolization was performed to treat the pseudoaneurysm and patient was subsequently started on anticoagulation therapy. Discussion Penetrating wounds to the buttock can result in associated vascular or visceral injuries. Pseudoaneurysms can develop days to years after the initial injury. On exam, presence of pain, swelling, tenderness, bleeding from wound, thrill, bruit or a pulsating mass should raise suspicion for pseudoaneurysm, which can be diagnosed on CT scan and treated with embolization. Conclusion Proper management of traumatic wounds to the buttock with associated vascular injuries, with follow up protocols and patient education is necessary to prevent life-threatening complications such as hemorrhage from pseudoaneurysm.
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Affiliation(s)
- Marine Coste
- SUNY Downstate Medical Center, Brooklyn, NY, USA.
| | - Dosuk Yoon
- Kings County Hospital, Department of Trauma/Acute Care Surgery, Brooklyn, NY, USA; Wyckoff Heights Medical Center, Department of Surgery, Brooklyn, NY, USA
| | - Mary Noory
- SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Valery Roudnitsky
- SUNY Downstate Medical Center, Brooklyn, NY, USA; Kings County Hospital, Department of Trauma/Acute Care Surgery, Brooklyn, NY, USA
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