基本信息
题目:
医源性肱动脉假性动脉瘤致正中神经压迫性神经失用症的诊断及超声下压迫疗法：一例罕见病例图像
Iatrogenic brachial artery pseudoaneurysm causing median nerve compression neuropraxia diagnosed and compression therapy ultrasonography: A rarest case image
作者及单位：
Alamgir Khan1*, Thamizh Selvan1, Arjun Ganpat Munde1, Manohar Kachare2
1
Department of Radiodiagnosis, Topiwala National Medical College, Mumbai, Maharashtra, India
2
Department of Radiodiagnosis, Government Medical College Miraj, Miraj, Maharashtra, India
引用格式：
Khan A, Selvan T, Munde AG, Kachare M. Iatrogenic brachial artery pseudoaneurysm causing median nerve compression neuropraxia diagnosed and compression therapy ultrasonography: a rarest case image. iRADIOLOGY. 2024; 2(3): 362–4. https://doi.org/10.1002/ird3.78
原文链接：
https://onlinelibrary.wiley.com/doi/10.1002/ird3.78
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主要内容
A 69-year-old male with a known history (Hx) of chronic kidney disease (CKD) was presented with a 2-day Hx of inability to flex the proximal and distal interphalangeal (DIP) joints of the first, second, and third digits of his left hand. Notably, he retained the ability to flex the proximal and DIP joints of the fourth and fifth fingers. This presentation followed balloon fistuloplasty (BF) performed to address stenosis of an arteriovenous fistula between the radial artery and cephalic vein.
Physical examination revealed swelling and erythema on the ventral aspect of left upper arm. He was referred for ultrasonography (USG) for the same.
Ultrasound imaging of the left upper arm was conducted. The examination revealed a well-defined cystic lesion measuring 27 × 7 × 10 mm, originating from the wall of the brachial artery. Doppler study demonstrated a “ying yang” sign on color Doppler, indicative of a pseudoaneurysm (PNA). Notably, the PNA was observed to pulsate against the median nerve (MN), leading to neuropraxia (Figure 1).
FIGURE 1 (a) Well defined thick wall cystic lesion was seen arising from the wall of brachial artery, which in Doppler study shows ying yang sign on color Doppler within suggestive of pseudoaneurysm; (b) The pseudoaneurysm was observed to pulsate against the median nerve, potentially leading to compression and subsequent neuropraxia.
Under ultrasound guidance, compression therapy for 15 min was performed and complete obliteration of lumen was achieved and was confirmed on Doppler study showing no flow in the lumen of PNA (Figure 2).
FIGURE 2 Post compression therapy complete obliteration of lumen was achieved and was confirmed on Doppler study showing no flow in the lumen of pseudoaneurysm.
Our case underscores the significance of prompt recognition and management of PNAs following vascular interventions. Utilization of high-resolution USG enables accurate diagnosis and facilitates targeted interventions such as compression therapy. Early intervention is essential to prevent potential neurological complications and optimize patient outcomes.
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