Carolinas Research Day 2021

Clinical Case-Based Studies

10 Brachial Artery Pseudoaneurysm: Yin-Yang Sign

Kayla Baker, OMS-III, Lindsay Tjiattas-Saleski, DO, MBA, FACOEP

Edward Via College of Osteopathic Medicine-Carolinas, Prisma Health Tuomey Hospital, Sumter, SC

Abstract: An 89-year-old male presented to the Emergency Department for a lump on his left upper extremity. He recently underwent a percutaneous left brachial artery access for splenic artery embolization. Post procedure, he developed swelling around the IV site. He also noted numbness in the fingers of his left hand and decreased grip strength. On physical exam, there was a mass over the left medial epicondyle region with no erythema, edema or warmth. The lesion did not feel pulsatile. His left upper extremity had decrease pincher grasp. Ultrasound of the left extremity revealed the lesion was most compatible with a pseudoaneurysm and he was referred to vascular surgery for treatment.

Pseudoaneurysms most commonly occur iatrogenically. They are a known complication of endovascular procedures with the femoral artery as the most common arterial access. (1) However, the occurrence of pseudoaneurysm from other arteries is on the rise, as the number of percutaneous procedures in the upper extremity has increased. (2) With the growing use of the upper extremity for endovascular access, awareness and recognition of a pseudoaneurysm as a post procedural complication is imperative. Pseudoaneurysms have a risk of rupturing and hemorrhage. In this case, the pseudoaneurysm created an opportunity for reversal of blood flow leading to signs of ischemia. This bidirectional blood flow can best be seen via ultrasound in the classic Yin-Yang sign.

References:

1. Rivera PA, Dattilo JB. Pseudoaneurysm. [Updated 2020 Sep 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/ NBK542244/ Tosti R, Özkan S, Schainfeld RM, Eberlin KR. Radial Artery Pseudoaneurysm. Journal of Hand Surgery. 2017 Apr 01; 42(4): 295.e1-295.e6. 2.

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