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Anesth Analg 2007;105:890-891
© 2007 International Anesthesia Research Society
doi: 10.1213/01.ane.0000269691.81976.67

LETTER TO THE EDITOR

Section Editor:
Lawrence Saidman

Portable Ultrasound to Diagnose True Radial Artery Aneurysm

C. Barker, FRCA, P. Jefferson, FRCA, and D. R. Ball, MBBS

Specialist Registrar in Anaesthesia; Department of Anaesthesia; Dumfries and Galloway Royal Infirmary; Dumfries, UK (Barker) Consultant in Anaesthesia; Department of Anaesthesia; Dumfries and Galloway Royal Infirmary; Dumfries, UK; dball{at}nhs.net (Jefferson, Ball)

To the Editor:

In a recent letter, Baumgarten (1) described the increasing application of ultrasound by anesthesiologists. True radial artery aneurysm is rare and we report one readily diagnosed by ultrasound at "point of care." An elderly man presented for revision vascular surgery. A pulsatile but nonexpansile swelling was seen at his wrist (Fig. 1) Allen's test was 15 s, suggesting the majority of the hand's blood supply was supplied by the aneurysmal radial artery. The swelling had been present for years and there was no history of previous trauma or cannulation. Portable ultrasound (I LookTM, SonoSite, Bothell, WA) confirmed the aneurysm (Fig. 2).


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  		Figure 1. Hand showing swelling at the wrist.

 

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  		Figure 2. Ultrasound image of the wrist swelling.

 

Swellings such as these can be misdiagnosed and present for excision. Of note are volar ganglia at the wrist (2). Indeed the radial artery may form part of a ganglion wall (3). Sonography is used to distinguish solid or cystic extravascular lesions around the wrist and distinguish them from the radial artery (4). Indeed, Doppler ultrasound is recommended as a standard investigation for volar wrist swelling (5). In our case, ultrasound allowed a rapid and accurate diagnosis.

REFERENCES

  1. Baumgarten R. The real ultrasound revolution. Anesth Analg 2007;104:1292[Free Full Text]
  2. Yaghoubian A, de Virgilio C. Noniatrogenic aneurysm of the distal radial artery: a case report. Ann Vasc Surg 2006;20: 784–6[Web of Science][Medline]
  3. Kerr CD, Duffey TP. Traumatic false aneurysm of the radial artery. J Trauma 1988;28:1603–4[Web of Science][Medline]
  4. Turner WH, Turnball AR. True radial artery aneurysm. Br J Surg 1988;75:233[Web of Science][Medline]
  5. Gooding GAW. Sonography of the radial artery at the wrist. Am J Roentgenol 1988;150:629–31[Abstract/Free Full Text]




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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press