Test Yourself

Case 1

HISTORY

A patient who had previously had an ilio-femoral bypass presented with a growing swelling in his left groin. He had noticed this after lifting a heavy object

ULTRASOUND FINDINGS

Ultrasound of the lump revealed a round echogenic structure which was consistent with the graft. Around this was a hypoechoic, irregular collection which was traced along the path of the graft. The mass was seen to pulsate.

Color Doppler revealed pulsatile flow both through the graft (as expected) and outside the graft which was traced to the distal anastomosis site. Flow was seen in the femoral artery distal to the anastomosis (not shown).

DISCUSSION

Collections around the anastomosis site can be haematoma, abscesses or leaks / false aneurysms. Color Doppler interrogation is important to distinguish between these. Mirror image artifact can cause color signal to appear outside the graft lumen, due to reflection from the echogenic graft, and will always appear deeper to the mirroring surface (away from the probe), regardless of the angle of insonation. True color signal will have an anatomically consistent site, independent of the position of the probe.

There is controversy regarding the relative accuracy of ultrasound versus CT to detect leaks (particularly for endovascular graft follow up).

SUBMITTED BY

Adrian Goudie


Left Groin trans

Left Groin trans

The round, echogenic graft can be seen in the inferior portion of the hypoechoic mass
Left Groin trans Left Groin Prox, long Left Groin Dist, long Left Groin Dist, long Trans Left Iliac Fossa to Groin Left Groin, long Left Groin, long color Doppler