Asian Journal of Case Reports in Surgery

Traumatic pseudoaneurysm of the brachial artery is uncommon and may be overlooked after apparently minor penetrating trauma, particularly when distal arterial flow is initially maintained. Progressive enlargement can subsequently produce ischaemic and neurological complications. We report a 34-year-old man who sustained a penetrating metallic umbrella-tip injury to the right cubital fossa and later developed a progressively enlarging painful swelling, paraesthesia and weakness in the median-nerve distribution. Examination revealed a bruit over the proximal elbow, prolonged capillary refill (>5 s), non-palpable radial and ulnar pulses, and peripheral oxygen saturation of 53% in the affected limb. Emergency Doppler ultrasonography demonstrated the characteristic “yin-yang” sign of a pseudoaneurysm. CT angiography subsequently showed a 2.0 × 1.0 cm pseudoaneurysm arising from the brachial artery bifurcation with distal radial and ulnar arterial opacification. Surgical exploration through a fasciotomy incision demonstrated a long-standing pseudoaneurysm causing significant median-nerve compression; the radial artery was found to be compromised. Following proximal and distal vascular control, the pseudoaneurysm was excised, simultaneously decompressing the median nerve. A reversed saphenous vein graft harvested from the left thigh was used to reconstruct arterial continuity from the brachial artery to the ulnar artery. Reperfusion was satisfactory, the fasciotomy wound was closed on postoperative day 2, and the patient was discharged on postoperative day 3 with subsequent outpatient follow-up. This case emphasises that apparently trivial penetrating trauma around the elbow can conceal a clinically important vascular injury and that new swelling, ischaemic signs or median-nerve symptoms warrant prompt vascular imaging and definitive treatment.