Working Diagnosis:
Recurrent left hip pain due to recurrent left hip hematoma secondary to medial profunda femoris artery pseudoaneurysm.

Treatment:
Patient received coil embolization via interventional radiology for treatment of her medial profundal femoris artery pseudoaneurysm.

Outcome:
One week after embolization, the patient was pain-free and able to start light workouts in gym class. She gradually returned to batting, with no high-impact activity over three weeks. After safe demonstration of her sport-specific tasks with physical therapy, she eventually returned to full play without restrictions.

Author's Comments:
Pseudoaneurysms are local hematomas contained by less than all three arterial layers (tunica intima, tunica media, and tunica externa/tunica adventitia). Profunda femoris pseudoaneurysms can often be due to either infection, trauma, vascular access, or surgery. As the pseudoaneurysm grows, groin swelling, pulsatile masses, and hip pain can all occur. Profunda femoris artery traction may have occurred with her iliopsoas tear. This report is unique due to the paucity of literature on profundal femoris pathology in the absence of femoral fracture, especially in pediatrics. Long-term treatment options include coil embolization, ultrasound-guided decompression, thrombin injection, or open surgical repair.

Editor's Comments:
Pseudoaneurysms are often referred to as "false aneurysms." They only include one to two layers of the artery wall, unlike a true aneurysm that affects all three artery wall layers.

Profunda femoris pseudoaneurysms are rare common complications related to fractures and orthopedic procedures of the upper thigh. There have been documented cases of profunda femoris pseudoaneurysms following blunt trauma.

Endovascular management with coil embolisation or stent placement is the preferred treatment. Surgery is reserved for cases where embolisation is not an option.

References:
1. Nguyen AS, Only AJ, Onizuka N, Switzer JA. Medial femoral circumflex artery pseudoaneurysm following intramedullary nailing for intertrochanteric fracture. Trauma Case Rep. 2021 Dec 9;37:100577. doi: 10.1016/j.tcr.2021.100577. PMID: 35005160; PMCID: PMC8715203.
2. Pandey NN, Raju SN, Rajagopal R, Kumar S. Iatrogenic profunda femoris artery pseudoaneurysm: late presentation with successful endovascular microcoil embolisation. BMJ Case Rep. 2018 Dec 9; 11(1):e228314. doi: 10.1136/bcr-2018-228314. PMID: 30567224; PMCID: PMC6301617.
3. Bloom AI, Sasson T, Verstandig A, Wolf YG, Anner H, Berlatzky Y, Akopnick I, Lotan C, Lederman R, Lebensart PD. Ultrasound-guided thrombin injection for the treatment of iatrogenic pseudoaneurysm of the femoral artery. Isr Med Assoc J. 2001 Sep;3(9):649-52. PMID: 11574979.

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