Delayed diagnosis of a false aneurysm after lumbar arterial injury: treatment with endovascular embolization: a case report.

STUDY

DESIGN

A case report is presented.

OBJECTIVES

To report a case of lumbar artery pseudoaneurysm that was primarily missed, and to discuss therapeutic options.

SUMMARY OF BACKGROUND DATA: In the literature, only a few cases of lumbar artery pseudoaneurysms have been reported. The diagnosis is difficult and often delayed, with a sometimes fatal outcome. The treatment is either surgery or endovascular embolization.

METHODS

In a patient who survived after a fall from 20 feet (6 m) height, a relatively small retroperitoneal hematoma detected during urgent splenectomy was underestimated. Two weeks later, the underlying laceration of the lumbar artery led to the formation of a pseudoaneurysm, which then ruptured causing a large retroperitoneal hematoma and gradual complete femoral nerve palsy.

RESULTS

Complete occlusion of the pseudoaneurysm and progressive regression of the retroperitoneal hematoma were achieved by two stages of endovascular embolization. The size of the hematoma was diminished gradually during a period of 12 months, whereas the femoral nerve has completely recovered.

CONCLUSIONS

Traumatic rupture of a lumbar artery is a rare complication of a blunt abdominal trauma. This condition leads to a potentially massive retroperitoneal hemorrhage and shock, or to subsequent pseudoaneurysm formation and delayed retroperitoneal hematoma. This condition can be managed with either surgical or preferably endovascular intervention provided the patient is hemodynamically stable.