Superior Gluteal Artery Pseudoaneurysm Presenting as a Gluteal Mass: Case Report and Review of Literature
A 38-year old female presented to the surgical clinic with pain and swelling in the left gluteal region. The swelling had gradually increased in size over 4 months. The pain was radiating to the left lower limb and associated with numbness. The patient had been involved in a road traffic accident two years earlier and had suffered a left acetabular fracture, which had been treated conservatively.\nPhysical examination revealed a large tender swelling in the left gluteal area simulating an abscess. However, pulsation was observed over the swelling that raised the suspicion of a vascular lesion. Therefore, contrast enhanced computed tomography (CT) was done before trying any intervention. The scan demonstrated a large pseudoaneurysm originating from the left superior gluteal artery measuring 6.4 × 5.8 × 3.4 cm with a small intra-pelvic component and large extra-pelvic component in the gluteal area []. This lesion appeared as a contrast-filled structure in direct communication with the superior gluteal artery. Its two components were communicating in the region of greater sciatic notch.\nMagnetic resonance imaging (MRI) was also performed for better assessment of this vascular swelling and any surrounding hematoma. The aneurysm demonstrated mixed signal intensities; with rounded central signal-void area representing the patent lumen, and a peripheral thick rim of high signal intensity on T1-weighted and low signal intensity on T2-weighted images denoting a thrombus/hematoma []. In addition, the signal void lumen showed some flow artifacts.\nThe patient was referred for endovascular treatment.Digital subtraction angiography (DSA) and transcatheter embolization were done in the same session. The aneurysm was approached by puncturing the right femoral artery and occluded by placing four coils and gelfoam in the feeding vessels [].\nRepeated CT angiography after 1 week confirmed exclusion of the aneurysm with only a residual hematoma in the area [Figure and ]. Patient had an uneventful recovery with the pain disappearing and gluteal swelling gradually regressing in size over several months. Follow-up MRI few months post-embolization showed significant reduction in the size of the hematoma [].