University Hospital Birmingham NHS Trust, Selly Oak, Birmingham, UK
Correspondence to: E. Rankin, Rheumatology, University Hospital Birmingham NHS Trust, Selly Oak, Birmingham B29 6JD, UK. E-mail: elizabeth.rankin{at}uhb.nhs.uk
SIR, A 69-yr-old woman with rheumatoid arthritis since 1970 was admitted in 2001 with right hip pain. She had had a right total hip replacement (THR) in 1976 requiring two revisions. She had further revision of the right THR in 2002. Pre-operative angiography was normal. Post-operatively, she again developed pain, tenderness and swelling in the right hip. Radiographs were unremarkable. Her haemoglobin (Hb) fell from 10.7 to 8.3 g/dl. Ultrasound examination of the right hip revealed a large hypo-echoic area, representing a haematoma. The Hb fell despite blood transfusions. A digital subtraction angiogram (DSA) of the right femoral vessels revealed a large pseudo-aneurysmal sac (Fig. 1) fed by the perforating branch of the profunda femoris artery. The pseudo-aneurysm was treated with a fibred coil embolization procedure (Fig. 2). Post-procedure, her Hb remained steady, and pain and swelling resolved.
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We are grateful to the patient, who gave written consent for us to describe her case, and to Dr Jubb, consultant rheumatologist, for his permission to describe this case.
The authors have declared no conflicts of interest.
Accepted 30 June 2005
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