Traumatic radial artery pseudoaneurysm

Chenxi Li, RT1; Guifang Mu, RT1; Zhanqi Wang, MD1; Furong Zhang, RT1; Pengyun Cheng, MD2; Xinglong Liu, MD2

1 Department of Radiology, Kezhou People’s Hospital, Xinjiang, P. R. China

2 Siemens Healthineers, China

A 34-year-old male patient accidentally injured his left forearm while chopping wood. Two weeks later, a small bulge appeared at the site of the wound and progressively grew. The patient was asymptomatic and otherwise healthy. He had an unremarkable medical history. An ultrasound examination revealed a suspicious radial artery pseudoaneurysm with thromboses. He was admitted to the hospital for further treatment. A CT angiography (CTA) examination was requested for preoperative evaluation.

CTA images showed a pseudoaneurysm, with a narrow and short pedicle, at the distal third of the radial artery, measuring 3.1 x 2.4 x 2.3 cm in size. Peripheral hypodense areas within the aneurysm were seen, suggesting thromboses. Subsequently, the patient underwent surgical resection of the pseudoaneurysm with primary end-to-end repair of the radial artery. The pathology result confirmed the CT findings. The patient recovered uneventfully.

cVRT images with different presets and an oblique MPR image show a pseudoaneurysm, with a narrow and short pedicle, at the distal third of the radial artery. Peripheral hypodense areas are seen, suggesting thromboses.

Courtesy of Department of Radiology, Kezhou People’s Hospital, Xinjiang, P. R. China

Fig. 1: cVRT images (Figs. 1a-1c) with different presets and an oblique MPR image (Fig. 1d) show a pseudoaneurysm (arrows), with a narrow and short pedicle, at the distal third of the radial artery. Peripheral hypodense areas (arrowheads) are seen, suggesting thromboses.

Radial artery pseudoaneurysms are rare and the radial artery is the least common location for peripheral artery pseudoaneurysms. These usually occur after a penetrating trauma or an iatrogenic injury. Prompt diagnosis and treatment are required to prevent the potential risk of external bleeding due to the rupture of the fragile outer wall. Treatment planning should take into consideration the location as well as the size of the pseudoaneurysm and the collateral arterial flow. This diagnostic information can be optimally provided by CT imaging. In this case, a lower kV setting of 80 kV is applied to improve the contrast-to-noise ratio, reducing the radiation exposure and the amount of contrast agent needed. Standard dose reduction techniques, such as CARE Dose4D (automatic controlled tube current modulation) and ADMIRE (Advanced Modeled Iterative Reconstruction) are applied as well. An advanced cinematic volume rendering technique (cVRT) is used to enable a lifelike image demonstration with a better 3D perspective as well as improved depth and shape perceptions, facilitating the communication with the patient and the surgeon.

Scanner

Scan area

Left forearm

Scan mode

Spiral mode

Scan length

471.1 mm

Scan direction

Caudo-cranial

Scan time

10 s

Tube voltage

80 kV

Effective mAs

93 mAs

Dose modulation

CARE Dose4D

CTDIvol

1.6 mGy

DLP

143.1 mGy*cm

Rotation time

0.5 s

Pitch

0.6

Slice collimation

128 x 0.6 mm

Slice width

1.0 mm

Reconstruction increment

0.7 mm

Reconstruction kernel

I26f, ADMIRE 3

Contrast

370 mg/mL

Volume

50 mL + 30 mL saline

Flow rate

4 mL/s

Start delay

Bolus tracking with 100 HU at the aortic arch + 5 s