Segmental vascular occlusion resulting from blunt trauma is rarely seen, especially in the absence of skeletal injury or other findings of major traumatic injury [1]. We report a case that was extremely unusual: femoral artery occlusion in the absence of any other findings, resulting from relatively minor trauma in an otherwise healthy child. Although this type of phenomenon is rare [1], the consequences of missing such an occurrence in a child can include retarded long-bone growth and even limb loss [2, 3]. Therefore, recognition of the CT appearance is imperative, and the vasculature must be carefully evaluated even when pathology is unsuspected. We present the CT findings in the setting of femoral artery occlusion, using four-slice CT.
An 11-year-old girl was admitted to an outside hospital after a fall on her bicycle. She sustained an injury to her left inguinal area from the handlebars of the bicycle and presented with left thigh pain and a cold left leg. An ultrasound at the outside hospital showed a possible tear with flap of the left femoral artery, and she was admitted to the pediatric emergency department at our institution for further evaluation.
From the emergency department, the patient was sent for multidetector row CT with a four-slice scanner (Volume Zoom Siemens Medical Solutions, Malvern, PA, USA). Scan parameters were 1 mm detector collimation, 1 mm slice thickness, 120 kVp, and 150 mAs, with data reconstructed at 0.75 mm intervals. Arterial phase imaging was obtained 25 s after intravenous injection of 120 cc of Omnipaque-350 (GE Healthcare, Princeton, NJ, USA). All data were transferred to a Leonardo workstation (Siemens Medical Solutions, Malvern, PA, USA), running InSpace Software. Three dimensional volume rendered and MIP reconstructions were performed interactively. CTA with 3-D reconstructions showed no evidence of fracture [Fig. 1]. However, a 2-cm long arterial segment at the junction of the left external iliac and superficial femoral artery did not opacify, consistent with arterial occlusion. No pseudoan-eurysm or AV fistula was seen.
Based on these findings, the patient underwent surgical exploration. A large clot was confirmed in the external iliac at the level of the inguinal ligament, and inspection of the artery revealed a complete disruption of the intima over a distance of approximately 1.5 cm. The artery was repaired using a graft made from the saphenous vein of the right groin. The patient made an uneventful recovery.