What’s the Diagnosis – Case 221
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Findings The MRI demonstrates extensive injury of the right sided anterior abdominal wall with complete avulsion of the right sided rectus adductor aponeurosis, injury extending into the adductor musculature, obturator musculature, pectineus, and gracilis. A large pelvic hematoma has formed and displaces the urinary bladder. A large hematoma extends into the scrotum as well. CT examination performed without contrast, with contrast administration for arterial enhancement, and delayed imaging for venous evaluation demonstrates a small irregularity adjacent to the right side of the pubis.
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Diagnosis: Traumatic Pseudoaneurysm of the Obturator Artery An extremely rare occurrence, and one that we encounter particularly infrequently, is the development of a pseudoaneurysm. Pseudoaneurysms occur following injury to a blood vessel, when blood leaking from the vessel becomes contained by a surrounding fibrous wall. In the trauma setting, these commonly occur following high-energy mechanisms of injury, such as motor vehicle collisions or significant blunt trauma. There is extremely sparse literature about pseudoaneurysms in professional sports, although they are known to occur. In this case, the massive shearing injury sustained by the anterior abdominal wall also led to injury of the blood vessel. This patient sustained their injury during a professional football game, although the exact mechanism is not entirely clear. The patient was admitted to the hospital because of pain and difficulty urinating. Serial examinations demonstrated a declining hematocrit level, prompting the CT angiography study. On the angiography study, the decision was made to perform multiple phases of imaging to allow detection of what could be a subtle but important finding. This proved to be the case as the subtle blush of the obturator artery on the post contrast studies became much more conspicuous with the precontrast imaging. This patient was transferred to the interventional radiology service and underwent selective embolization of the vessel. He is now hemodynamically stable and will undergo repair of the extensive anterior abdominal wall injury imminently.
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