A 6-year-old female child presented with a painful, expansile swelling at the medial aspect of her right thigh. Three months earlier she had an open reduction Internal fixation of a closed fracture of mid-shaft of right femur. An angiogram confirmed pseudoaneurysm of the superficial femoral artery caused by overpenetration of the dynamic compression plate screw. It was treated surgically by resection of the aneurysm, reconstruction with inter-positional sephanous vein graft and removal of the hardware. On the last followup at 12 months, the patient was symptom free with resumption of normal activities of everyday life. Introduction Isolated Superficial femoral artery (SFA) pseudoaneurysms occur rarely in younger age group and are mostly post-traumatic, while in older populations, most of these aneurysms are atherosclerotic and often associated with infections, inflammatory, immunologic or connective tissue disorders.1,2 Most patients with non-atherosclerotic pseudoaneurysms of SFA are asymptomatic initially and later present with a pulsatile, expanding mass along the anatomical course of SFA in the thigh and have a history of some trauma or surgical procedure.1,9,14 We report a case of a child who developed pseudoaneurysm of the superficial femoral artery following an internal fixation of the mid-shaft fracture of femur. Case Report A 6-year-old female child sustained a closed mid-shaft fracture of the right femur in a fall while playing at her school. She was immediately transferred to a local hospital where an open reduction and internal fixation (ORIF) was done with a dynamic compression plate (DCP). The hospital course was uneventful and she was discharged a week after the fixation. Three months after the ORIF, she presented in the emergency room with a gradually expanding swelling on medial aspect of proximal 1/3rd of her right thigh for the past two months. The swelling was the size of a golf ball, pulsatile, moderate to severely tender and soft on palpation with no change in color of the overlying skin. An incorrect anatomical fixation was observed with slight external rotation of the right limb and mild limb length discrepancy; however, there was no gross mal-rotation present. The patient was vitally stable with ESR of 24, white blood cell count of 9.1x 109/L, hemoglobin of 10.8 gm/dl, hematocrit of 32.7% and a completely healed fracture on an X-ray. A possible pseudoaneurysm was suspected, and an angiogram was done on the same day which established the diagnosis of a saccular pseudoaneurysm of the right superficial femoral artery with a distal most DCP-screw in contact with it (see Figure 1).
展开▼
