24 year old male presents to the trauma unit after a stab wo | Figure 1

24 year old male presents to the trauma unit after a stab wound to the abdomen.

He was persistently hypotensive and several operations were performed to repair small bowel lacerations and ligate bleeding mesenteric vessels. He remained unstable with high transfusion requirements so IR was consulted for angiogram with possible intervention. What is the diagnosis? Comment below with your thoughts. The answer and intervention will be posted tomorrow!

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1. This is a peroneal artery arteriovenous fistula with a small pseudoaneurysm. Coils were placed in the peroneal artery to occlude the fistula and pseudoaneurysm. After coiling of the peroneal artery, good anterior tibial and posterior tibial runoff with backfilling of peroneal artery was observed. No abnormal waveform or flow was observed after coiling. There was no residual pseudoaneurysm.

2. The hepatic hyperdensities on the previous CT images are arterial aneurysms. Two contrast-enhanced images taken at the onset of abdominal pain reveal intraparenchymal bleeding consistent with rupture.

3. The CT showed the large necrotic pseudocyst with definite contrast extravasation consistent with an arterial pseudoaneurysm.

4. This was a visual explanation of both the disease process and treatment plan we shared with the patient and spouse to give them a better understanding of the surgical plan.

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