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Added value of contrast-enhanced ultrasound (CEUS) with Sonovue® in the diagnosis of inferior epigastric artery pseudoaneurysm: report of a case and review of literature

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Abstract

The anatomical position of the inferior epigastric artery (IEA), within the rectus sheath, subjects patients to possible IEA injury during abdominal wall surgical and interventional procedures. Pseudoaneurysm arising from IEA is very uncommon with only 16 cases reported in the literature. We present a case of an IEA false aneurysm resulting from therapeutic paracentesis for ascites in a 71-year-old patient who came to our department for abdominal pain and signs of anemization. To our knowledge, no published reports are currently available describing an IAE pseudoaneurysm successfully diagnosed with contrast-enhanced ultrasound.

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Authors and Affiliations

  1. Motor Science and Wellness Department, University of Naples “Parthenope”, Via F. Acton 38, 80133, Naples, Italy

    Antonio Corvino

  2. Radiology Department, National Cancer Institute Pascale Foundation, Via M. Semmola 53, 80131, Naples, Italy

    Fabio Sandomenico & Sergio Venanzio Setola

  3. Vascular and Interventional Radiology Department, Cardarelli Hospital, Via A. Cardarelli 9, 80131, Naples, Italy

    Fabio Corvino

  4. Radiology Department, Marcianise Hospital, Via Santella, 81025, Marcianise, CE, Italy

    Fabio Pinto

  5. Radiology Unit, Istituto Diagnostico Varelli, Via Cornelia dei Gracchi 65, 80126, Naples, Italy

    Orlando Catalano

  6. Casal di Principe, Italy

    Antonio Corvino

Authors
  1. Antonio Corvino
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  2. Fabio Sandomenico
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  3. Sergio Venanzio Setola
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  4. Fabio Corvino
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  5. Fabio Pinto
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  6. Orlando Catalano
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Each author has participated sufficiently in any submission to take public responsibility for its content.

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Correspondence to Antonio Corvino.

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Written informed consent was obtained from all patients, and the study was approved by the ethics committee of the institution.

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Video 1

On real-time US examination, a “smoky swarm” of small–medium echoes in a whirling motion (smoke-like effect, a very familiar finding to echocardiographers) is well appreciated within the hypo-anechoic area (MP4 1208 kb)

Video 2

Color-Doppler real-time video shows more clearly a pulsating color jet within the hypo-anechoic area synchronous with arterial pulse. This Doppler finding restricts the differential diagnosis (active bleeding or pseudoaneurysm) but does not permit further diagnostic evaluations (MP4 1195 kb)

Video 3

Real-time CEUS examination from the Sonovue® injection to 45 s allows us in observing the pulsating nature of the hyperechoic jets of contrast agent, which begins from the communication point with AEI, fill the PA cavity with a “whirling” appearance, up to a complete PA homogenization of during the late phase. In addiction, a slowly filling of the epigastric lymph node is also evident (MP4 14973 kb)

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Corvino, A., Sandomenico, F., Setola, S.V. et al. Added value of contrast-enhanced ultrasound (CEUS) with Sonovue® in the diagnosis of inferior epigastric artery pseudoaneurysm: report of a case and review of literature. J Ultrasound 22, 485–489 (2019). https://doi.org/10.1007/s40477-019-00398-x

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  • DOI: https://doi.org/10.1007/s40477-019-00398-x

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