Man With Groin Pulsatile Hematoma

Case Presentation

A 70-year-old man with a medical history of diabetes, chronic kidney disease, and bilateral peripheral arterial disease, presented to the emergency department with bleeding from the puncture site in his right groin where he had undergone percutaneous transluminal angioplasty nine days earlier. His vital signs were normal. Upon cleaning the wound, a pulsatile hematoma was found in his right groin ( Fig. 1 A). The laboratory test didn’t show thrombocytopenia or coagulopathy. Point-of-care ultrasonography was performed ( Fig. 1 B).

Fig. 1 . (A) Clinical photograph of the patient’s right groin displays a pulsatile hematoma at the puncture site of the femoral artery for percutaneous transluminal angioplasty. (B) Ultrasonography of the right inguinal area shows a pseudoaneurysm (arrowheads) communicating with the common femoral artery (arrows) through a neck (N). The color Doppler image shows the presence of flow within the pseudoaneurysm.

Diagnosis: Iatrogenic Femoral Artery Pseudoaneurysm

The common femoral artery is a frequently used access site for diagnostic and interventional procedures, including angiograms, angioplasty, and stent deployment. 1 However, there is a potential risk of femoral arterial pseudoaneurysm formation after these procedures, with reported incidence rates of 0.2% for diagnostic procedures and 8.0% for interventional procedures. 1 Risk factors for pseudoaneurysm formation include lengthy interventional procedures, large device insertion, inadequate post-procedure compression, and anticoagulant therapy. 1 The most severe complication is rupture, which is more likely to occur in pseudoaneurysms larger than 3 cm. 2 Ultrasound is a useful diagnostic tool with a high sensitivity (94%–97%). 1 The treatment choices for this condition include ultrasonography-guided compression (around 80% success rate), ultrasonography-guided thrombin injection, (around 95 % success rate), and surgical repair if previous treatments fail. 2

In this case, he received ultrasonography-guided compression followed by sandbag compression and was discharged uneventfully three days later. A follow-up computed tomography angiography performed three weeks later showed spontaneous resolution of the pseudoaneurysm ( Fig. 2 ).

Fig. 2 . Computed tomography angiography of (A) axial and (B) sagittal views performed three weeks after conservative management, showing the spontaneous resolution of the pseudoaneurysm (arrowheads) from the common femoral artery (arrows).