Daniels Steven P, Sneag Darryl B, Berkowitz Jennifer L, Trost David, Endo Yoshimi
Department of Radiology, New York Presbyterian Hospital-Weill Cornell Medical Center, 525 East 68th Street, Box 141, New York, NY, 10065, USA.
Department of Radiology and Imaging, Hospital for Special Surgery, 535 E. 70th Street, New York, NY, 10021, USA.
Skeletal Radiol. 2019 May;48(5):699-706. doi: 10.1007/s00256-018-3084-4. Epub 2018 Oct 10.
To describe the clinical presentation of arterial pseudoaneurysms following total knee arthroplasty (TKA) and their diagnostic imaging features on ultrasound and magnetic resonance angiography (MRA) in 7 patients.
A search of our radiology report database from 2007 to 2017 yielded 7 patients with a pseudoaneurysm diagnosed by imaging after TKA. Clinical notes and imaging were reviewed.
All 7 patients were male and ranged in age from 53 to 68 (mean 61) years. All patients presented with a painful swollen knee and hemarthrosis within the first month following surgery. Five patients presented after primary TKA. One patient presented after explantation for septic arthritis and another after partial synovectomy for septic arthritis without explantation. Ultrasound identified the pseudoaneurysm as a hypoechoic or hyperechoic mass with a "yin-yang" appearance of turbulent arterial flow and associated complex joint effusion. On MRA, the pseudoaneurysm was a mass next to a parent artery showing avid contrast enhancement in the arterial phase that persisted into the venous phase and washed out in the late venous phase. Six pseudoaneurysms arose from lateral geniculate arteries and 1 from a medial geniculate artery. There were no popliteal artery pseudoaneurysms. Five patients were treated endovascularly, 1 patient thrombosed without intervention, and 1 patient was treated with open surgery.
Pseudoaneurysm is a potential source of a painful swollen knee with hemarthrosis or a drop in hematocrit after TKA and can be identified with either ultrasound or MRA.
描述7例全膝关节置换术（TKA）后动脉假性动脉瘤的临床表现及其在超声和磁共振血管造影（MRA）上的诊断影像学特征。
检索我们2007年至2017年的放射学报告数据库，发现7例TKA后经影像学诊断为假性动脉瘤的患者。回顾临床记录和影像学资料。
所有7例患者均为男性，年龄53至68岁（平均61岁）。所有患者在术后第一个月内均出现膝关节疼痛肿胀和关节积血。5例患者为初次TKA后出现。1例患者在因化脓性关节炎行假体取出术后出现，另1例在因化脓性关节炎行部分滑膜切除术后未取出假体出现。超声检查将假性动脉瘤识别为低回声或高回声肿块，具有动脉血流紊乱的“阴阳”表现，并伴有复杂的关节积液。在MRA上，假性动脉瘤是位于母动脉旁的肿块，在动脉期显示明显的对比剂强化，持续至静脉期，并在静脉晚期消退。6例假性动脉瘤起源于膝外侧动脉，1例假性动脉瘤起源于膝内侧动脉。未发现腘动脉假性动脉瘤。5例患者接受了血管内治疗，1例患者未经干预血栓形成，1例患者接受了开放手术治疗。
假性动脉瘤是TKA后膝关节疼痛肿胀伴关节积血或血细胞比容下降的潜在原因，超声或MRA均可识别。
