Case report 374: Post-traumatic pseudoaneurysm of axillary artery

Differential Diagnosis of Thoracoacromial Artery Pseudoaneurysm from Shoulder Inflammatory Pseudotumor: A Case Report

Diagnosing shoulder tumors is a challenge because the joint is very complex, and a static examination can misdiagnose some tumors. However, we found that a pseudoaneurysm provides a differential diagnosis of a tumor, and to that end, we present a case that mimics shoulder infection. The patient was an 80-year-old female who had a history of coronary artery disease and end-stage renal disease under regular hemodialysis and complained of right shoulder swelling and progression. A magnetic resonance imaging (MRI) scan revealed an abscess, inflammatory pseudotumor (IPT), and osteomyelitis of the humerus. Computed tomography (CT)-guided pigtail drainage was performed twice without significant improvement. An angiogram revealed a right shoulder pseudoaneurysm fed by the acromial branch of the thoracoacromial artery. After endovascular coiling, the patient was discharged and outpatient follow-up was arranged. If aspiration of the abscess leads to only mild improvement in shoulder swelling, further evaluation should be arranged. An angiogram examination is a good method for diagnosing and designing operations, and endovascular treatment is good for preventing injury to the muscle, tendon, nerve, or blood vessels.

Arterial pseudoaneurysms of the shoulder mimicking other entities: utilization of pulsation artifact on musculoskeletal MR for accurate diagnosis in 2 cases

We present two cases of pseudoaneurysm (PSA) about the shoulder mimicking more common clinical entities-soft tissue neoplasm and septic arthritis-for which biopsy of the mass and joint aspiration were requested respectively. We review the imaging findings of PSA with emphasis on findings in musculoskeletal protocol MRI, including the identification of pulsation artifact in both cases, which was critical to establishing the correct diagnosis. In the proper clinical setting, with imaging findings demonstrating a complex mass or fluid collection, MR images should be scrutinized for the presence of pulsation artifact, which can help diagnose a high-flow vascular lesion and avoid a potentially harmful invasive procedure such as biopsy.

[Rupture of axillary artery and brachial plexus paralysis as complications of recurrent anterior glenohumeral dislocation: a case report]

The authors report a case of transection of the axillary artery and brachial plexus paralysis following recurrent anterior glenohumeral dislocation. Subsequent vascular reconstruction was performed using a venous interposition graft. The brachial plexus was explored at the same time and found to be in continuity. Neurological recovery was complete within a few months.

Pseudoaneurysms Occurring as a Result of Fractures Giving Rise to the Appearance of Pseudotumors: A Short Series

Pseudoaneurysms are focal enlargements of the vascular lumen due to partial or complete disruption of the arterial wall. These are an uncommon complication of fractures. The presence of a pseudoaneurysm adjacent to a fracture fragment can cause a pressure effect. This pressure not only impairs fracture healing but sometimes can erode the adjacent bone, producing the appearance of a pseudotumor. We present two such cases and discuss the management of these patients.

Acute complications associated with shoulder dislocation at an academic Emergency Department

Shoulder dislocation is the most frequent dislocation treated in the Emergency Department (ED). Orthopedic literature cites up to a 55% incidence of fracture, vascular or neurologic injury associated with this injury, but these studies suffer from referral bias. No large ED series has been reported. This retrospective chart review was conducted in an academic ED for patients with shoulder dislocation presenting July 1, 1995-June 30, 2000. There were 263 charts identified; 73 were miscoded and 5 were lost, leaving 190 for analysis. Mean age was 34.3 years. Fifty-five patients had at least one fracture (29%), 48 of which (76%) were of the Hill-Sachs type. Despite presence of a fracture, all shoulders underwent successful ED reduction. Sensory nerve deficits were found in 24 (12.6%), which persisted after reduction in 25% of these patients. No vascular injuries were identified. The finding of fracture in 33% of patients with shoulder dislocation is in the range of rates reported in the orthopedic literature (15-55%). The finding that, despite the presence of a fracture, all underwent successful closed reduction is important, as one-third of these patients will have this condition. Neurologic deficits in 12% is significantly lower than the 21-65% reported in the orthopedic literature. Although complications associated with shoulder dislocation were relatively common, they did not significantly affect ED management.

Complications of shoulder dislocation

Dislocations of the shoulder are the most common joint dislocations seen in the emergency department, and complications of shoulder dislocations are more frequent than is generally believed. It is vital that emergency physicians have current knowledge of complications associated with shoulder dislocations because of their important role in recognition and prevention. Delayed recognition of complications can have an impact on the long-term outcome of patients. Prompt recognition and follow-up are essential. Most references address reduction methods rather than recognition of specific complications. Emergency physicians have few opportunities to update their knowledge of complications of shoulder dislocations. This article briefly reviews mechanisms of shoulder dislocation and discusses complications in light of the mechanisms of injury.

Late vascular complication after fracture of the proximal humerus

A case of late vascular complication after a fracture of the proximal humerus is presented. The main clinical feature was neurological loss of the brachial plexus, while angiography showed no rupture or false aneurysm. The long delay before surgical intervention caused irreversible damage to the nerves. Early diagnosis and surgical intervention are emphasized.

Axillary aneurysm after shoulder injury. A report of 2 cases

Two cases of false aneurysm of the axillary artery occurred after closed shoulder injuries. One was a dislocation of the shoulder, and the other was a fracture of the lesser tuberosity. In both cases the diagnosis was delayed, and only became apparent after excessive bruising was seen.