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Vascular » Peripheral Vascular
Peroneal artery pseudoaneurysm with calf hematoma
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Author(s) :
Chaitali Shah, FRCR
Presentation A 49 year old man status post motor vehicle accident and resultant left tibial and fibular fractures presents with left calf swelling for a week. He had been treated surgically for the fractures. An ultrasound of the left lower limb was performed.
Caption: Extended field of view of the left calf
Description: A large, hypoechoic, predominantly cystic mass is seen in the left calf corresponding to the region of swelling. Significant echoes are seen within the mass.
Caption: Transverse color Doppler view of the area of calf swelling
Description: No internal flow is recorded in the calf mass.
Caption: Color Doppler proximal to the abnormal calf area
Description: A vessel is seen coursing in close proximity to the calf mass, which most likely based on its location, appears to be an arterial branch. The vessel superficial to it possibly represents the posterior tibial vein.
Caption: Transverse color Doppler view in the abnormal area
Description: A branch from the vessel that is coursing close to the calf mass exhibits apparent dilatation and appears to lead into the hypoechoic mass.
Caption: Spectral Doppler analysis in the abnormal area
Description: A characteristic to and fro pattern is noted in the vessel proximal to the dilated branch that led to the mass.
Caption: Follow up ultrasound scan
Description: As marked by the arrows, there is an echogenic coil seen in the peroneal artery. The vessel superficial to it, which is the vein, appears normal.
Caption: Follow up sagittal ultrasound scan
Description: The peroneal artery,occluded by the echogenic coil, is noted again and shows no flow on color Doppler.
Caption: Follow up scan demonstrating the calf mass
Description: The hematoma appears to have decreased in size following the coil occlusion procedure. The dilated arterial branch seen previously is not noted in this image.
Caption: Spectral analysis of the occluded vessel
Description: The to and fro pattern that was seen earlier is not seen now and the arterial branch is truly occluded.
Differential Diagnosis Peroneal or posterior tibial branch artery pseudoaneurysm
Final Diagnosis Peroneal artery pseudoaneurysm with  calf hematoma
Follow Up This patient underwent an angiogram and subsequent successful vascular coil occlusion of the left peroneal artery pseudoaneurysm. Follow up Doppler scans showed occlusion of the vessel and a decrease in the size of the calf hematoma.
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