Radiology, Vol 170, 363-366, Copyright © 1989 by Radiological Society of North America
Pulsatile masses surrounding vascular prostheses: real-time US color flow imaging
JF Polak, MC Donaldson, AD Whittemore, JA Mannick and DH O'Leary
Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA 02115.
A prospective evaluation of color flow mapping and real-time ultrasound was
performed to determine if pseudoaneurysms could be distinguished from other
causes of masses surrounding vascular grafts of the lower extremities.
Twelve palpable pulsatile masses were imaged. Diagnoses were confirmed at
angiography (n = 11), computed tomography (n = 7), aspiration biopsy (n =
5), and operative intervention (n = 6). A swirling pattern of blood flow
was seen in six of seven cases of pseudoaneurysm. Lack of flow signals was
noted in four of the five collections representing hematoma (n = 2) or
infection (n = 2). The seventh case was later shown to be an infected,
thrombosed pseudoaneurysm. The single false-positive diagnosis was made
early in the series when the flow signals detected were due to transmitted
arterial pulsations. The authors conclude that color Doppler flow imaging
is useful in the differential diagnosis of pulsatile masses associated with
prosthetic grafts. Prosthetic graft pseudoaneurysms have a specific
appearance of swirling blood flow arising from a wide neck and are
distinguishable from traumatic or iatrogenic pseudoaneurysms of the native
vascular tree.
