Spontaneous peroneal pseudoaneurysm in the young athlete

Background

Pseudoaneurysm represents an unusual cause of unilateral extremity pain in the acute care setting. However, a growing body of literature supports its inclusion in the standard differential for acute-onset extremity pain. Consideration for pseudoaneurysm is particularly justified in management of pediatric patients, who may bear undiagnosed syndromes conferring increased risk of vascular injury.

Case report

We present an unusual case of acute onset unilateral extremity pain in an otherwise healthy 17-year-old male resulting from spontaneous peroneal artery rupture with pseudoaneurysm identified on emergent angiography. In this case, pseudoaneurysm was complicated by compartment syndrome necessitating four compartment fasciotomy and washout with delayed closure.

Why should an emergency physician be aware of this?

Our discussion reviews current evidence for emergent vascular imaging in the pediatric population. If there is a high suspicion for pseudoaneurysm or other vascular emergency, providers should prioritize computed tomography with angiography over magnetic resonance. Prompt diagnosis is critical to avert progression to compartment syndrome and/or disability. We also discuss the known causes of pseudoaneurysm and conclude that the finding of spontaneous pseudoaneurysm should trigger evaluation for related genetic and rheumatologic disorders with the aim of mitigating morbidity and mortality related to the underlying disease process.