Ann Rehabil Med.  2012 Apr;36(2):287-290. 10.5535/arm.2012.36.2.287.

Arteriovenous Malformation Incidentally Found by Ultrasonography in a Thigh Hematoma after Contusion

• Lee HJ
• Kwon BS
• Kwon JH
• Park JW
• Ryu KH
• Cha DY
• Shim JH
• Lim WH

• KMID: 2266771
• DOI: http://doi.org/10.5535/arm.2012.36.2.287

Abstract

Vascular malformations in extremities are difficult to detect in cases of minor trauma. The authors report a case of an arteriovenous malformation (AVM) incidentally found by ultrasonography in a contusion. After a slip down, a 52-year-old man who had undergone total arthroplasty in both hips 10 years earlier complained of an ovoid right hip swelling that had gradually increased in size. Suspecting a simple cyst or hematoma, the swelling was examined by ultrasonography, which revealed a subcutaneous hematoma with arterial flow connected to muscle. Arteriography revealed an AVM around the right hip joint. Due to the presence of multiple arteriovenous shunts, a conservative treatment course was adopted and after 3 weeks of treatment the swelling almost completely resolved. It appears that the small AVM may have existed congenitally before hip surgery and the contusion over the AVM had led to hematoma rather than an arteriovenous fistula. The authors emphasize the usefulness of ultrasonography for the diagnosis of posttraumatic swelling.

Keyword

Arteriovenous malformations; Contusions; Ultrasonography

MeSH Terms

Angiography
Arteriovenous Fistula
Arteriovenous Malformations
Arthroplasty
Contusions
Extremities
Hematoma
Hip
Hip Joint
Humans
Middle Aged
Muscles
Thigh
Vascular Malformations

Figure

• 

  Fig. 1 High frequency ultrasonography of the lateral thigh. The hypoechoic ovoid mass filled with heterogenous hypoechoic material showed posterior acoustic enhancement (interpreted as a cystic mass containing debris and hematoma) in subcutaneous tissue above the fascia of the vastus lateralis. Power Doppler mode (B) and color Doppler mode (C) showed pulsatile arterial blood flow through a stalk between the cystic lesion and the vastus lateralis.

• 

  Fig. 2 Arteriovenous malformation of the right thigh. Right common femoral angiogram shows feeding arteries (long arrow), a dense nidus of malformation (double arrows) in the thigh, and early opacification of draining veins (thick arrow).

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