Pseudoaneurysm of the anterior tibial artery detected by emergency medicine physician performing bedside ultrasound

Abstract

We present the case of an anterior tibial artery pseudoaneurysm secondary to lacerating trauma caused by a straight-edge trimming blade. A 56-year-old man presented to emergency department (ED) with 1-month history of left calf pain. Thirty days before presentation, the patient lacerated his left lateral pretibial area with a cutting blade--similar to a machete--while cutting grass. He was seen at the state hospital, and primary suture was performed. Ten days later, the suture was removed. A week later, the patient revisited his physician, complaining of swelling and tenderness in the left calf. Hematoma formation of the calf was suspected and aspirated by syringe. Three days later, the patient presented to the ED with a repeat of his symptoms. On physical examination, the calf was swollen and tender. The vascular examination revealed a palpable dorsalis pedis and diminished posterior tibialis pulse. Localized swelling was present, and circumference of the affected calf was increased. No pulsatile mass was palpated. Ultrasound (US) performed at the bedside revealed a pulsating anechoic lesion surrounded by a hypoechoic lesion suggestive of thrombus formation. Doppler US of the patient showed 4.5x2.5-cm partially thrombosed pseudoaneurysm of the anterior tibial artery. In this case, the pseudoaneurysm was believed to be compressing the posterior tibial artery, resulting in a diminished pulse on examination. Emergency US use may enhance emergency physician performance by the shortening of the length of stay in the ED, reduce the number of unnecessary tests to be ordered, and hasten critical therapeutic interventions.