This case study is on a 5-month old female born at 36 weeks of gestation who presents with a large brachial artery pseudoaneurysm. After consultation with vascular and pediatric surgery it was decided to take a conservative approach for treatment.
The patient was referred to the vascular lab for serial duplex ultrasounds to monitor any changes. Over a period of six months, four duplex ultrasounds were performed by separate senior technologists.
Initial color duplex imaging revealed a partially thrombosed pulsatile structure arising off the left brachial artery in the mid arm measuring 2.86cm x 2.63cm consistent with a pseudoaneurysm. Patent area of flow was noted to measure 2.22cm x 1.28cm. Pendulum waveforms noted of the neck with a velocity of 306cm/sec. Flow in the residual pseudoaneurysm presented with a velocity of 98cm/sec. Repeat ultrasounds were performed at seven days, one month, two months and six months. Results of the six-month ultrasound showed complete resolution of the left brachial artery pseudoaneurysm.
After several months of careful observation and conservative management with the use of external compression, the patient was found to have complete spontaneous resolution of the left brachial artery pseudoaneurysm after six months. The patient was managed conservatively as the nature of the pseudoaneurysm was asymptomatic and serial duplex exams showed improvement over time.
Mannan Vohra, Vascular Technologist, University of Chicago Medicine