A Rare Cause of Post-traumatic Right Lower Extremity Swelling in an Adolescent Male.

Abstract

Unilateral extremity swelling after trauma usually results from acute musculoskeletal or orthopedic injuries. Worsening of swelling raises concern for compartment syndrome or vascular injury. Time-sensitive diagnosis and interventions are needed to avoid life- or limb-threatening consequences. In this report, we highlight the case of a 16-year-old male who presented with unilateral lower extremity pain and swelling, one week after a motor vehicle accident. Thorough evaluation and appropriate imaging detected the presence of an abnormal communication between the muscular branch of the anterior tibial artery and the vein. Arteriovenous fistulas (AVFs) are usually acquired and caused by penetrating trauma or iatrogenic procedures. They are rarely associated with blunt trauma. It is important to determine the degree of flow within the communication, as high flow lesions are associated with severe complications such as limb ischemia and heart failure. This report highlights the evaluation and management of a patient with delayed post-traumatic unilateral extremity swelling that eventually resulted in the diagnosis of a low-flow AVF amenable to conservative management, resulting in complete resolution of his symptoms.