Abstract
BackgroundTraumatic vascular injury of the limbs has the potential to cause substantial patient morbidity and mortality, and therefore, early recognition and treatment are crucial to improve outcomes. While patients with hard signs of arterial injury mandate for an immediate surgical intervention, patients presenting with soft signs of arterial injury need further diagnostic evaluation.Case presentationA 24-year-old male was admitted to the emergency department after suffering a stab wound in the anterolateral aspect of his left upper thigh. Entry wound measures approximately 3 cm × 0.7 cm; no exit wound was observed. On examination of the injured limb, the thigh was swollen and painful. Skin color was mildly pale and skin temperature was slightly diminished in his leg; leg numbness was also pointed out by the patient. Common femoral artery pulse was normal, while distal pulses were diminished. Point-of-care Doppler ultrasound (DUS) showed a subfascial hematoma in the thigh, which filled on color Doppler, corresponding to a pseudoaneurysm. On spectral Doppler, signs of distal low blood supply were noted. The patient was immediately transferred to the operating room where a 1-cm laceration was found in the anterior aspect of the superficial femoral artery. The involved artery was successfully repaired and distal flow was reestablished, as assessed by clinical examination, pulse palpation and DUS.ConclusionsBased on its several advantages, DUS should be considered as the first-line diagnostic tool in the diagnostic workup of patients with soft signs of arterial injury.
Highlights
Based on its several advantages, Doppler ultrasound (DUS) should be considered as the first-line diagnostic tool in the diagnostic workup of patients with soft signs of arterial injury
Vascular injuries represent less than 3% of all traumatic findings and have a potential to cause morbidity and mortality if they are not timely recognized and treated [1–4]
We present hereby the case of a patient with stab injury of the superficial femoral artery demonstrated by pointof-care DUS and how the use of this method impacted in decision-making
Summary
Vascular injuries represent less than 3% of all traumatic findings and have a potential to cause morbidity and mortality if they are not timely recognized and treated [1–4]. Among patients with arterial injury, those presenting with “hard signs” of arterial injury (e.g., pulsatile bleeding, expanding hematoma, absent distal pulses, cold/pale limb, palpable thrill or an audible bruit) mandate for an immediate surgery and vascular repair without the support of diagnostic imaging techniques. We present hereby the case of a patient with stab injury of the superficial femoral artery demonstrated by pointof-care DUS and how the use of this method impacted in decision-making. Given that arterial injury sounded unequivocal based on clinical examination and DUS findings, the patient was immediately transferred to the operating room for surgical exploration. Skin color and temperature of the affected limb were normal, the patient indicated disappearance of his leg numbness, and distal pulses were full. Patient follow-up was uneventfully and he was discharged from the hospital on day 5
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