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Acute Limb Ischaemia and a Disguised Pseudoaneurysm: A Rare Presentation of a Femoral Osteochondroma

INTRODUCTION: Vascular complications occurring secondary to osteochondroma are a rare phenomenona. They typically present insidiously with claudication, however, uncommonly may present with acute limb ischaemia. We present a case of a young boy who presented with acute limb ischaemia secondary to os...

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Autores principales: Rodham, Paul, Shelmerdine, Lauren, McCaslin, James, Beckingsale, Tom
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Indian Orthopaedic Research Group 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7276618/
https://www.ncbi.nlm.nih.gov/pubmed/32548006
http://dx.doi.org/10.13107/jocr.2250-0685.1534
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author Rodham, Paul
Shelmerdine, Lauren
McCaslin, James
Beckingsale, Tom
author_facet Rodham, Paul
Shelmerdine, Lauren
McCaslin, James
Beckingsale, Tom
author_sort Rodham, Paul
collection PubMed
description INTRODUCTION: Vascular complications occurring secondary to osteochondroma are a rare phenomenona. They typically present insidiously with claudication, however, uncommonly may present with acute limb ischaemia. We present a case of a young boy who presented with acute limb ischaemia secondary to osteochondroma with an intraoperative diagnosis of popliteal pseudoaneurysm. CASE REPORT: A 15-year-old male presented with an acutely ischaemic limb. A computed tomography CT angiogram was performed which demonstrated complete occlusion of his popliteal artery secondary to a tumour of the distal femur. The patient underwent an open biopsy of the tumour followed by thrombectomy which failed to resolve the ischaemia. After further unsuccessful attempts at thrombectomy, angiography was performed which revealed a pseudoaneurysm. . The patient underwent a successful popliteal exclusion bypass using ipsilateral reversed long saphenous vein. The lesion was subsequently identified as an osteochondroma. The patient made a good recovery and at his latest follow-up is ambulant, free from claudication, and demonstrates good flow through the bypass on duplex ultrasonography. CONCLUSION: Acute limb ischaemia is a rare occurrence within the adolescent population and will, therefore, frequently be secondary to an uncommon aetiology. Whilst While osteochondroma are is a common cause of vascular complications in this population, the onset of symptoms is usually more insidious. The acute onset, in this case, therefore, raised uncertainty as to the potential for malignancy. The management of these patients should involve a combination of both vascular and orthopaedic surgery in order to return perfusion whilest also ensuring the offending lesion is managed appropriately. In patients where initial measures do not restore perfusion, then the potential for further complications such as pseudoaneurysm should be considered and managed promptly.
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spelling pubmed-72766182020-06-15 Acute Limb Ischaemia and a Disguised Pseudoaneurysm: A Rare Presentation of a Femoral Osteochondroma Rodham, Paul Shelmerdine, Lauren McCaslin, James Beckingsale, Tom J Orthop Case Rep Case Report INTRODUCTION: Vascular complications occurring secondary to osteochondroma are a rare phenomenona. They typically present insidiously with claudication, however, uncommonly may present with acute limb ischaemia. We present a case of a young boy who presented with acute limb ischaemia secondary to osteochondroma with an intraoperative diagnosis of popliteal pseudoaneurysm. CASE REPORT: A 15-year-old male presented with an acutely ischaemic limb. A computed tomography CT angiogram was performed which demonstrated complete occlusion of his popliteal artery secondary to a tumour of the distal femur. The patient underwent an open biopsy of the tumour followed by thrombectomy which failed to resolve the ischaemia. After further unsuccessful attempts at thrombectomy, angiography was performed which revealed a pseudoaneurysm. . The patient underwent a successful popliteal exclusion bypass using ipsilateral reversed long saphenous vein. The lesion was subsequently identified as an osteochondroma. The patient made a good recovery and at his latest follow-up is ambulant, free from claudication, and demonstrates good flow through the bypass on duplex ultrasonography. CONCLUSION: Acute limb ischaemia is a rare occurrence within the adolescent population and will, therefore, frequently be secondary to an uncommon aetiology. Whilst While osteochondroma are is a common cause of vascular complications in this population, the onset of symptoms is usually more insidious. The acute onset, in this case, therefore, raised uncertainty as to the potential for malignancy. The management of these patients should involve a combination of both vascular and orthopaedic surgery in order to return perfusion whilest also ensuring the offending lesion is managed appropriately. In patients where initial measures do not restore perfusion, then the potential for further complications such as pseudoaneurysm should be considered and managed promptly. Indian Orthopaedic Research Group 2019 /pmc/articles/PMC7276618/ /pubmed/32548006 http://dx.doi.org/10.13107/jocr.2250-0685.1534 Text en Copyright: © Indian Orthopaedic Research Group http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Rodham, Paul
Shelmerdine, Lauren
McCaslin, James
Beckingsale, Tom
Acute Limb Ischaemia and a Disguised Pseudoaneurysm: A Rare Presentation of a Femoral Osteochondroma
title Acute Limb Ischaemia and a Disguised Pseudoaneurysm: A Rare Presentation of a Femoral Osteochondroma
title_full Acute Limb Ischaemia and a Disguised Pseudoaneurysm: A Rare Presentation of a Femoral Osteochondroma
title_fullStr Acute Limb Ischaemia and a Disguised Pseudoaneurysm: A Rare Presentation of a Femoral Osteochondroma
title_full_unstemmed Acute Limb Ischaemia and a Disguised Pseudoaneurysm: A Rare Presentation of a Femoral Osteochondroma
title_short Acute Limb Ischaemia and a Disguised Pseudoaneurysm: A Rare Presentation of a Femoral Osteochondroma
title_sort acute limb ischaemia and a disguised pseudoaneurysm: a rare presentation of a femoral osteochondroma
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7276618/
https://www.ncbi.nlm.nih.gov/pubmed/32548006
http://dx.doi.org/10.13107/jocr.2250-0685.1534
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