In a challenging case at Manipal Hospital Yeswanthpur, Bengaluru, Karnataka, a 9-month-old infant successfully underwent surgery for a radial artery aneurysm, a rare vascular condition seen in children. When the infant was just 6 months old, the parents first noticed a pulsating bulge on the baby’s right wrist. Concerned parents, consulted with multiple doctors in their hometown, Davangere, Karnataka. However, it was not clearly diagnosed and required further diagnostic methodologies.
The parents were then sent to Dr. Rajendra Prasad, a Senior Consultant in vascular and Endovascular Surgery at Manipal Hospital, Yeswanthpur. The infant was extensively examined with Doppler tests, CT scans, and MR angiograms. The reports confirmed the presence of an aneurysm in the right radial artery, a major blood vessel responsible for supplying oxygenated blood to the lower arm, wrist and hand.
This is an extremely rare case of an idiopathic pediatric radial artery aneurysm, with no apparent etiology. Such deadly a condition if left untreated would lead to complications involving the risk of rupture of an aneurysm, blood loss and limb loss.
An ‘aneurysm’ generally refers to abnormal swelling in the walls of an artery, which if left untreated can have fatal complications. The incidence of radial artery aneurysms is extremely rare, accounting for only 2.9% of all upper extremity aneurysms. [1]
An expansile impulse, a bruit, and a compressible mass
Pain and tenderness at the site of aneurysm
Coldness of the fingers, at the affected artery [2]
The exact cause of radial artery aneurysms is not well understood. However, case reports suggest it may result from trauma, atherosclerosis, infections (mycotic), Buerger’s disease, Granulomatous arteritis, or arterial cannulation. Non-invasive methods such as Duplex Doppler, CT and MRI arteriography help in the diagnosis and preoperative planning. [3]
The condition should be intervened rapidly to reduce the risk of local and systemic complications like thromboembolism, rupture, hemarthrosis, adjacent nerve irritation, paresthesia, limited wrist mobility, skin ulceration, and secondary infection. [1]
Treatment Options: The treatment involves surgical resection of the aneurysm and arterial reconstruction with anastomosis (ligature of the vessel). [3]
In this rare and complex case, Dr. Prasad emphasized that there are currently no recognized diagnosis or treatment guidelines for pediatric peripheral artery aneurysms, highlighting the case's rarity and complexity. Even though it was challenging, surgical intervention was needed to prevent further complications and restore the baby’s health.
Dr Prasad and his team successfully excised the aneurysm, without causing any damage to the surrounding tissues or arteries, thereby preserving the blood supply to the hand. Post-surgery there were no signs of hand ischemia, and the baby was recovering well. Continuous close monitoring is going on during the follow-up visits.
This case highlights, despite the challenges and complexity of the case the expert team with timely surgical intervention treated the infant with a rare vascular condition.
References:
"Idiopathic True Aneurysm of Distal Radial Artery: Case Report." Accessed January 20, 2025. https://www.tandfonline.com/doi/epdf/10.2147/VHRM.S182788?needAccess=true.
Lee, M. C. "True Aneurysm of the Radial Artery: Report of a Case with Long‐Term Follow‐Up." Journal of the American Geriatrics Society. 1977. Accessed January 20, 2025. https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/j.1532-5415.1977.tb00664.x.
"Radial Artery Aneurysm in the Anatomical Snuff Box: A Case Report and Literature Review." Accessed January 20, 2025. https://www.sciencedirect.com/science/article/pii/S2210261216303108?ref=pdf_download&fr=RR-2&rr=905501dcb8f17fd0.
(Input from various media sources)
(Rehash/Dr Disha Merlyn Mathias/MSM)