永存坐骨动脉瘤伴周围血肿误诊分析OA

Objective To analyze the causes of misdiagnosis and mistreatment of persistent sciatic artery aneurysm(PSAA)with perianeurysmal hematoma,and to explore preventive measures.Methods A retrospective analysis was conducted on the clinical data and treatment process of a patient with PSAA and perianeurysmal hematoma who was admitted in July 2024.Results This patient presented with pain and numbness in the right buttock and right thigh for over two months.Initially,the diagnosis was considered to be a lumbar spine lesion,but the treatment was ineffective.Afterwards,a mass was palpated in the right buttock,which gradually increased in size and was tender,with a palpable pulsation and vascular murmurs that could be heard.A pelvic CT angiography(CTA)showed dilation of the right internal iliac artery,and a visible aneurysmal protrusion was visible in its branch(the inferior gluteal artery),with patchy slightly high-density shadows around it.The enhancement scan did not show any enhancement.Nodular calcification shadows were observed within the lesion.A right internal iliac artery angiography revealed that the inferior gluteal artery in the right buttock was thickened,and a cystic contrast agent retention shadow was observed at its distal end.This was considered to be a pseudoaneurysm of the right inferior gluteal artery.The patient subsequently underwent balloon occlusion and embolization of the right inferior gluteal artery.After the surgery,the patient's right hip and right thigh pain were relieved,but the numbness in the right lower limb persisted.After consultation,neurotrophic and analgesic symptomatic treatment was given.Two weeks after discharge,the patient still had pain in the right hip and right thigh,and the numbness in the right lower limb persisted.Follow-up CTA of the pelvis and right lower limb showed post-embolization changes of the right internal iliac artery,with reduction in the extent of the perianeurysmal hematoma compared with previous imaging.The right femoral artery was found to be slender.A detailed review of the preoperative right lower limb CTA and digital subtraction angiography images showed that the right internal iliac artery was significantly thickened,a circular aneurysm was seen at its distal end,and a blood vessel was connected at the far end of the aneurysm,with slow blood flow.Combined with clinical symptoms and imaging manifestations,the diagnosis was right PSAA.The misdiagnosis lasted 15 d.Telephone follow-up for one year showed that the patient's overall condition was good,but the patient still had pain and numbness in the right thigh.Conclusion The persistent sciatic artery is a rare congenital vascular anomaly,often complicated by aneurysm formation.Therefore,a deeper understanding of the mechanism of its occurrence,its anatomical characteristics,and its clinical significance,as well as making an accurate diagnosis,will help clinicians formulate individualized treatment plans and avoid direct embolization of the aneurysm,which could lead to serious consequences.