Vascular malformations in extremities are difficult to detect in cases of minor trauma. The authors report a case of an arteriovenous malformation (AVM) incidentally found by ultrasonography in a contusion. After a slip down, a 52-year-old man who had undergone total arthroplasty in both hips 10 years earlier complained of an ovoid right hip swelling that had gradually increased in size. Suspecting a simple cyst or hematoma, the swelling was examined by ultrasonography, which revealed a subcutaneous hematoma with arterial flow connected to muscle. Arteriography revealed an AVM around the right hip joint. Due to the presence of multiple arteriovenous shunts, a conservative treatment course was adopted and after 3 weeks of treatment the swelling almost completely resolved. It appears that the small AVM may have existed congenitally before hip surgery and the contusion over the AVM had led to hematoma rather than an arteriovenous fistula. The authors emphasize the usefulness of ultrasonography for the diagnosis of posttraumatic swelling.

Citations

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• Malformação arteriovenosa incomum em artroplastia total do quadril: relato de caso de um perioperatório de curso complicado
  Nicholas Dahlgren, Roshan Jacob, Colin Cantrell, Mackenzie Sowers, Ashish B. Shah, Sameer Mahadeorao Naranje
  Revista Brasileira de Ortopedia.2023; 58(05): e818.     CrossRef
• Congenital Brachial Arteriovenous Fistula
  Dalila White, Mark Badgett, John K. Petty, Nitin Garg
  Journal for Vascular Ultrasound.2016; 40(4): 174.     CrossRef

Objective: We documented childhood strokes in this hospital to ascertain the causes of childhood strokes and the proportion of stroke types.

Method: We reviewed the medical records and brain imaging studies of all children with possible strokes who were admitted to Asan Medical Center from 1990 to 1999. Our review of charts identified 131 acute childhood stroke patients aged from one to eighteen years old. Results: Seventy boys (53.4%) and 61 girls (46.6%) were involved in this study. The predominant diagnoses responsible for the stroke were arteriovenous malformation (42.0%) and moyamoya disease (24.4%). The diagnoses of 30 stroke patients (22.9%) were undetermined, 16 of them were ischemic and 14 hemorrhagic. The total number of hemorrhagic stroke was almost twice as that of ischemic stroke. As patients aged, the incidence of ischemic stroke decreased while the opposite trend was observed in hemorrhagic stroke. There were 14 death (10.7%) consisting of 13 hemorrhagic stroke patients and 1 ischemic during the admission period. Relapse of stroke were noted in 19 of 131 patients (14.5%) with the main cause being arteriovenous malformation.

Conclusion: Although the main diagnoses of childhood strokes were arteriovenous malformation and moyamoya disease, the cause of strokes in 23% could not be confirmed. The incidence of ischemia decreased while that of hemorrhage increased with the increase in age. Death, relapse, and complication occurred more frequently in hemorrhagic than ischemic stroke.