Pseudo-aneurysm of the anterior tibial artery, a rare cause of ankle swelling following a sports injury

BACKGROUND: Ankle pain and swelling following sports injuries are common presenting complaints to the accident and emergency department. Frequently these are diagnosed as musculoskeletal injuries, even when no definitive cause is found. Vascular injuries following trauma are uncommon and are an extremely rare cause of ankle swelling and pain. These injuries may however be limb threatening and are important to diagnose early, in order that appropriate treatment can be delivered. We highlight the steps to diagnosis of these injuries, and methods of managing these injuries. It is important for clinicians to be aware of the potential for this injury in patients with seemingly innocuous trauma from sports injuries, who have significant ankle pain and swelling. CASE PRESENTATION: A young, professional sportsman presented with a swollen, painful ankle after an innocuous hyper-plantar flexion injury whilst playing football, which was initially diagnosed as a ligamentous injury after no bony injury was revealed on X-Ray. He returned 2 days later with a large ulcer at the lateral malleolus and further investigation by duplex ultrasound and transfemoral arteriogram revealed a Pseudo-Aneurysm of the Anterior Tibial Artery. This was initially managed with percutaneous injection of thrombin, and later open surgery to ligate the feeding vessel. The patient recovered fully and was able to return to recreational sport. CONCLUSION: Vascular injuries remain a rare cause of ankle pain and swelling following sports injuries, however it is important to consider these injuries when no definite musculo-skeletal cause is found. Ultrasound duplex and Transfemoral arteriogram are appropriate, sensitive modalities for investigation, and may allow novel treatment to be directed percutaneously. Early diagnosis and intervention are essential for the successful outcome in these patients

An unusual pulmonary condition presenting following trauma

An 18-year-old man presented to the emergency department following an assault. He complained of left-sided pleuritic chest pain and difficulty breathing. Clinical examination revealed reduced air entry and coarse crepitations at the left lung base. A chest x-ray showed a large opacity at the left lung base that contained multiple cystic areas with air-fluid levels. Due to the history of trauma, a provisional diagnosis of a ruptured hemidiaphragm with small bowel herniation was made. Further imaging, including ultrasound, spiral computed tomography and magnetic resonance angiography, showed an aberrant vessel supplying the opacity and drainage into the pulmonary venous system. A diagnosis of a bronchopulmonary sequestration (intralobar type) was made. The differential diagnosis of the radiographic appearance is also discussed

Critical Science Plan for the Daniel K. Inouye Solar Telescope (DKIST)

Open Access funding provided by the National Solar Observatory (NSO). The NSO is operated by the Association of Universities for Research in Astronomy, Inc., and is funded by the National Science Foundation.The National Science Foundation’s Daniel K. Inouye Solar Telescope (DKIST) will revolutionize our ability to measure, understand, and model the basic physical processes that control the structure and dynamics of the Sun and its atmosphere. The first-light DKIST images, released publicly on 29 January 2020, only hint at the extraordinary capabilities that will accompany full commissioning of the five facility instruments. With this Critical Science Plan (CSP) we attempt to anticipate some of what those capabilities will enable, providing a snapshot of some of the scientific pursuits that the DKIST hopes to engage as start-of-operations nears. The work builds on the combined contributions of the DKIST Science Working Group (SWG) and CSP Community members, who generously shared their experiences, plans, knowledge, and dreams. Discussion is primarily focused on those issues to which DKIST will uniquely contribute.Publisher PDFPeer reviewe