Maertens Alexandra, Tchoungui Ritz Frederica Jessie, Poumellec Marie Anne, Camuzard Olivier, Balaguer Thierry
Reconstructive and Plastic Surgery Service, CHU-Nice, Senegal.
Reconstructive and Plastic Surgery Service, CHU-Nice, Senegal; Faculty of Medicine, Pharmacy and Odontology, Cheikh Anta Diop University, PO Box: 5005, Dakar, Senegal.
Int J Surg Case Rep. 2020;75:317-321. doi: 10.1016/j.ijscr.2020.09.029. Epub 2020 Sep 11.
Hand and Upper limb pseudoaneurysms are uncommon and misdiagnosed. The delayed diagnostic and treatment lead to severe vascular and nerve complications. Many mechanisms are involved like acute injury, chronic micro traumatism of the hand, with specific clinic and para clinic signs.
The patient was a 30-years old woman, right-handed, admitted at the emergencies for a penetrating hand injury at the junction of the middle third - distal third of the left forearm, palmar surface, with a good radial and ulnar pulse, without sensory or motor deficit. No vessels injuries observed per operatively. A post-operative worsened pain opposite to the scar with a purplish pulsatile swelling appeared after 20 days of complete wound healing. A needle puncture with a red blood contain, motivated an US Doppler revealing a pseudoaneurysm of a superficial artery of the ulnar artery, surgically resected, without complication.
Two main mechanisms are involved in upper limb especially hand pseudoaneurysm: penetrating trauma and repeated micro traumatism. Superficial vessels are rarely damaged compare to deep subfascial vessels according to Laplace law. The diagnostic is clinical confirmed with the medical imaging. A pseudoaneurysm is suspected in front of a pulsatile painful tumefaction following a vessel path, with medical imaging in favor. A delayed misdiagnosis lead to a delayed care with severe complications as thrombosis, embolism and vessel. The therapeutic care is mainly surgical.
This case reports a delayed diagnostic of posttraumatic pseudoaneurysm of a superficial branch of the ulnar artery, managed with a surgical resection.
手部及上肢假性动脉瘤并不常见且易被误诊。诊断和治疗的延迟会导致严重的血管和神经并发症。其涉及多种机制，如急性损伤、手部慢性微创伤，并伴有特定的临床和辅助检查体征。
患者为一名30岁女性，右利手，因左前臂掌侧中下段交界处穿透性手部损伤急诊入院，桡动脉和尺动脉搏动良好，无感觉或运动功能障碍。术中未发现血管损伤。伤口完全愈合20天后，瘢痕对侧出现疼痛加剧，伴有紫色搏动性肿胀。穿刺抽出红色血液，经超声多普勒检查发现尺动脉一条浅表分支假性动脉瘤，行手术切除，无并发症。
上肢尤其是手部假性动脉瘤主要涉及两种机制：穿透性创伤和反复微创伤。根据拉普拉斯定律，与深筋膜下血管相比，浅表血管很少受损。诊断需结合临床及医学影像学检查。当出现沿血管走行的搏动性疼痛性肿块时，应怀疑假性动脉瘤，医学影像学检查有助于确诊。诊断延迟会导致治疗延迟，进而引发严重并发症，如血栓形成、栓塞和血管病变。治疗主要采取手术方式。
本病例报告了一例尺动脉浅表分支创伤后假性动脉瘤的延迟诊断，通过手术切除进行治疗。
