PULSATING MASS AFTER ACCIDENTAL ARTERY TRAUMA - DIAGNOSIS WITH DUPLEXULTRASOUND AND THE ROLE OF ANGIOGRAPHY

Background: Pulsating mass located close to peripheral arteries is usu ally considered as a result of arterial wall injury. Clinically import ant is to distinct pseudoaneurysm from haematoma and also to evaluate proximal and distal arterial bed for the assessment of the injury exte nt. A few previous reports claim good results of duplex Doppler US dia gnosis of iatrogenic (post-catheterization) femoral artery injuries. T his paper presents diagnostic findings of arterial injuries caused by accidental trauma. Patients and Methods: A retrospective analysis of 4 9 patients with post-traumatic pulsating mass close to peripheral arte ry was performed. The diagnostic results of both sonography and angiog raphy were reviewed. All the patients underwent B-mode and duplex Dopp ler US examination using PW-, color- and power Doppler imaging techniq ues. Results: 34 pseudoaneurysms were diagnosed correctly with typical B-mode, color/power Doppler images and PW-Doppler spectral waveforms. The lack of flow signal and distinctive B-mode images enabled proper diagnosis of 13 haematomas. In 2 patients duplex Doppler US misdiagnos is occured, because of secondary pseudoaneurysm formation, primary dia gnosed as haematoma. The 47 correct US findings gave 96% efficacy in d istinguishing pseudoaneurysm from haematoma, which compares well with the other studies. In 20 patients suffering from peripheral ischemia, US examination, in spite of proper distinction between pseudoaneurysm and haematoma was unable for precise estimation of proximal and distal arterial damage. Thus, it was successfully supported with angiography before surgical decision making. Angiography was also necessary in 8 patients with severe injuries of carotid, subclavian and palmar arch a rteries, hardly accessible for ultrasound penetration. Conclusions: We conclude that duplex Doppler US is essential for noninvasive, unequiv ocal distinction between pseudoaneurysm and haematoma but it could not completely replace contrast angiography in the evaluation of post-tra umatic pulsating mass caused by severe, extensive trauma, frequently c omplicated with peripheral ischemia or located in regions with poor ac cess for ultrasound penetration.