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Portable Ultrasound to Diagnose True Radial Artery Aneurysm

Section Editor(s): Saidman, LawrenceBarker, C FRCA; Jefferson, P FRCA; Ball, D R. MBBS

doi: 10.1213/01.ane.0000269691.81976.67
Letters to the Editor: Letters & Announcements
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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@nhs.net (Jefferson, Ball)

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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 Look™, SonoSite, Bothell, WA) confirmed the aneurysm (Fig. 2).

Figure 1

Figure 1

Figure 2

Figure 2

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.

C. Barker, FRCA

Specialist Registrar in Anaesthesia

Department of Anaesthesia

Dumfries and Galloway Royal Infirmary

Dumfries, UK

P. Jefferson, FRCA

D. R. Ball, MBBS

Consultant in Anaesthesia

Department of Anaesthesia

Dumfries and Galloway Royal Infirmary

Dumfries, UK

dball@nhs.net

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REFERENCES

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