• Liang Li, Junqing Xiu, Lian Yuan, Xing Zhang, and Yue Li.
• Department of Ultrasound, Guang'anmen Hospital, China Academy of Traditional Chinese Medicine.
• Medicine (Baltimore). 2022 Aug 19; 101 (33): e30103e30103.

RationalePseudoaneurysm (PSA) is a common complication related to vascular intervention, and surgical therapy is the primary method. However, a giant brachial artery PSA over 2 weeks is rarely observed. Due to the adhesion of surrounding tissue, thrombus organization, the extensive injury, and the high expense of transluminal stent-graft placement, a single ultrasound-guided local high-dose thrombin injection can be a therapy option. Such cases are rarely reported.Patient ConcernsA 71-year-old man with a history of left elbow fossa interventional puncture presented to our hospital with a pulsatile mass in the left elbow fossa. He had a history of cerebral infarction 32 years prior without sequelae, emphysema for more than 2 years, hyperlipidemia for 3 months, and prostatic hyperplasia for 8 months. After conservative therapy, the lumbar compression fracture produced by trauma 24 years ago healed, and the intracranial hematoma induced by trauma ten years ago was absorbed.DiagnosisUltrasound examination showed giant mixed echoes on the posterior medial side of the left brachial artery.InterventionsThe patient underwent a single ultrasound-guided local high-dose thrombin injection to treat giant brachial artery PSA.OutcomesFollowing therapy, the ultrasonography revealed that extensive thrombosis immediately formed in the cavity, and the internal blood flow signals had completely vanished. A week later, a physical examination showed that the PSA had shrunk with no apparent tenderness and that the texture had hardened. Pulsation and vascular murmurs disappeared. Ultrasound showed that the PSA was reduced, and no blood flow signals were found.LessonsA single ultrasound-guided local high-dose thrombin injection had a considerable effect in curing large iatrogenic PSA. However, when deciding on the best therapy, specificity must be taken into account.Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

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