Pseudoaneurysm Leading to Necrotizing Fasciitis at the Femoral Arterial Puncture Site
A 46-year-old woman with symptoms of hemoptysis underwent bronchial angiography via the femoral artery. The patient's premorbid conditions were liver cirrhosis, chronic renal failure, diabetes mellitus, and obesity. However, upon the patient's return to the emergency room, she had a huge hematoma at the femoral arterial puncture site. Color-flow Doppler ultrasonography revealed a giant hematoma and hemorrhagic liquid at various concentrations in the upper third of the right thigh (). Angiography revealed a PA of the superficial femoral artery. Thrombolysis and bleeder ligation with Gelfoam were performed twice by an interventional radiologist. However, on the fourth postoperative day, the patient developed intense thigh swelling accompanied by bleeding from the surgical wound, induration, and marked tenderness. Seven days later, she was diagnosed with necrotizing fasciitis of the upper thigh, abdomen, and perineum (). A laboratory study revealed that the white blood cell count was 12,870/µL, ESR level was 29 mm/hr, and CRP level was 28.48 mg/dL (normal range, 0-0.5 mg/dL); all these values were mildly elevated. Further, the CK-MB level was elevated to 10.7 ng/mL (normal range, 0.1-5.8 ng/mL) and the myoglobin level was elevated to 565 ng/mL (normal range, 22-75 ng/mL). The sodium level was found to be 142, which was a slightly lowered level, and BUN was 27.3 mg/dL (normal range, 8-20 mg/dL). The necrotic wound was serially excised, and treatment was performed with the VAC device. The VAC therapy was conducted for a period of 21 days. However, the patient died of multiorgan failure and aspiration pneumonia.