Abstract
Background
Pseudoaneurysms of the foot are rare and can occur from a range of etiologies, including
laceration from a foreign body. The majority of reported cases have been diagnosed
by computed tomography, magnetic resonance imaging, or angiography. These tests require
intravenous access and contrast, confer radiation, take time to perform and interpret,
are expensive, and are not always readily available in the acute setting. No prior
reported pseudoaneurysms of the foot have been diagnosed by point-of-care ultrasound
(POCUS).
Case Report
An 8-year-old boy presented to the emergency department for evaluation of left foot
pain and swelling 2 weeks after stepping on small pieces of broken glass. He had a
3 × 3 cm area of painful swelling and erythema at the medial plantar aspect of his
foot. A cutaneous abscess was the working diagnosis and preparations were made for
an incision and drainage procedure. However, POCUS revealed a medial plantar artery
pseudoaneurysm. Incision and drainage would have led to unexpected arterial bleeding.
Instead, the pediatric surgery service was consulted for pseudoaneurysm excision and
arterial ligation.
Why Should an Emergency Physician Be Aware of This?
Incision of a pseudoaneurysm in the sole of the foot—thought to be an abscess based
on clinical examination—would lead to unforeseen arterial bleeding. POCUS at the bedside
can differentiate between simple abscess and pseudoaneurysm in order to guide appropriate
and time-sensitive management. Historical and clinical clues to the diagnosis may
include heavier-than-expected bleeding at the time of laceration and a pulsatile quality
to the painful erythema and swelling.
Keywords
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Article info
Publication history
Published online: March 31, 2020
Accepted:
February 15,
2020
Received in revised form:
January 20,
2020
Received:
July 8,
2019
Footnotes
Streaming videos: Six brief real-time video clips that accompany this article are available in streaming video at www.journals.elsevierhealth.com/periodicals/jem. Click on Video Clips 1–6.
Identification
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