Delayed presentation of a lumbar artery pseudoaneurysm resulting from isolated penetrating trauma

Abstract

Lumbar artery pseudoaneurysms are infrequent complications of penetrating trauma. When present, they are often accompanied by other injuries; however, we report the case of an isolated traumatic lumbar artery aneurysm resulting from a single knife stab. The lesion was successfully treated with endovascular microcoil embolization. While these injuries are uncommon, the surgeon must maintain a high index of suspicion, even with seemingly uncomplicated injuries, as a missed traumatic pseudoaneurysm may be life threatening.

Figure 1:

Contrast-enhanced CT scan of the lower abdomen and pelvis showing a single lobe of a presumed, bilobed pseudoaneurysm (a) as well as a 3.5 × 5.5 × 6 cm rim-enhancing, lobular collection of the superior right gluteal subcutaneous tissues, just superior to the right iliac crest and lateral to the paraspinal musculature, consistent with a hematoma (b).

Figure 2:

Axial cut from the same contrast-enhanced CT scan of the lower abdomen and pelvis showing a 1.6-cm bilobed, enhancing lesion, consistent with pseudoaneurysm, presumably extending from a branch of a right lumbar artery (a).

Figure 3:

Digital subtraction angiography showing a small pseudoaneurysm originating from the peripheral aspect of the distal right lumbar artery (a).

Figure 4:

Digital subtraction angiography demonstrating successful embolization of the proximal and distal entry points of the pseudoaneurysm using platinum microcoils (a).