PMC3328980_01
A 35-year-old female with end-stage renal disease and ascitis with a palpable right iliac fossa mass following paracentesis. High-frequency transverse ultrasound image demonstrates a mass (m) between internal oblique muscle (iom) and transversus abdominis muscle (tam) with a central sonolucent center.
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F1
The ultrasound examination (done on IE-33, Philips medical system, Netherlands) using a 7 - 11 MHz high-frequency linear array transducer, revealed a large, mixed echogenecity mass in the anterior abdominal wall of the right iliac fossa, with a sonolucent center [Figure 1].
Color flow Doppler demonstrates right iliac fossa pseudoaneurysm with Yin and Yang sign. Arrow points to the neck of the pseudoaneurysm.
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F2
A color Doppler study demonstrated a hypervascular nidus, with a swirling of red and blue colors with a feeding vessel arising from the deep circumflex iliac artery [Figure 2].
Spectral Doppler at the level of the neck of the pseudoaneurysm demonstrates "To and fro sign".
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F3
The Duplex Doppler of the neck of the feeding vessel demonstrated 'to and fro' sign suggestive of a pseudoaneurysm[Figure 3].
Axial unenhanced CT scan of the abdomen demonstrates a hyperdense lesion in the right anterior abdominal wall (arrow).
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F4
The unenhanced images showed a hyperdense mass within the anterior abdominal wall of the right iliac fossa [Figure 4].
Three-dimensional (3-D) computed tomography angiography image in arterial phase, volume rendered (VR) with maximum intensity projection (MIP) shows a small pseudoaneurysm arising from the distal part of the ascending branch of the right deep circumflex iliac artery (DCIA) (arrowhead). Inferior epigastric artery (IEA) is seen medial to it.
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F5
The arterial phase demonstrated a small nodular enhancement, approximately 4 mm in size, in the course of the ascending branch of the deep circumflex iliac artery, confirming the pseudoaneurysm [Figure 5].
Follow-up ultrasound after three weeks. (a) High resolution gray scale and (b) color Doppler, images of right iliac fossa show normal DCIA (arrow) with complete resolution of the pseudoaneurysm and the associated hematoma.
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F6
On a subsequent follow-up, there was significant reduction in the size of the pseudoaneurysm and the associated hematoma at one week, with complete resolution at about three weeks [Figure 6], as observed on the ultrasound / color Doppler studies.