The Role of Ultrasound Diagnosis of Traumatic Arteriovenous Fistula of the Brachial Artery

Objective. To demonstrate the importance and necessity of ultrasound diagnostics in case of traumatic injury of the upper extremities of various types on the example of a clinical case of detection of volumetric formation of soft tissues of the right upper limb of a false aneurysm and arteriovenous fistula of the brachial artery during ultrasound scanning.

Materials and Methods. Information about the patient's medical history, protocols, laboratory and radiation examination methods.

Results. In a victim with a combined gunshot wound to the chest, abdomen, limbs, and a closed craniocerebral injury in the lower third of the right shoulder, a volumetric pulsating formation measuring 10 × 8 × 8 cm was visually determined, during ultrasound scanning of soft tissues and main vessels of the right limb, defects in the walls of the brachial and radial arteries were revealed with the formation of a pulsating hematoma in the soft tissues of the right shoulder and forearms, defects in the walls of the brachial artery and vein at the level of the lower third of the right shoulder with the formation of an arteriovenous junction between them. The presence of an arteriovenous fistula and pseudoaneurysm were also confirmed during CT angiography. Due to the timely and high–quality radiation diagnosis, the patient underwent successful surgical treatment — resection of the brachial artery aneurysm of the right upper limb, separation of the arteriovenous fistula.

Conclusion. Ultrasound scanning of soft tissues and main vessels of the extremities in case of their traumatic damage, unlike other methods of radiation diagnostics, allows noninvasively, without radiation load, timely and mobile assessment of the state of blood flow in the affected limb, to identify the presence of hematomas, false aneurysms and arteriovenous fistulas and distinguish them from each other based on the spectral characteristics of blood flow and vascular staining in the mode of color Doppler mapping, which was carried out to a wounded man with damage to the right upper limb, who was suspected of having a soft tissue hematoma at the initial examination, and during an ultrasound scan was diagnosed as a false aneurysm and arteriovenous fistula of the brachial artery.

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