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Extranodal Peripelvic and Periureteric Lymphoma—Demonstration with Computed Tomography
422
CLINICAL RADIOLOGY
doi:10.1053/crad.1999.0285, available online at http://www.idealibrary.com on
Extranodal Peripelvic and Periureteric Lymphoma ± Demonstration with Computed Tomography S T E P H E N E . J . CO N N O R , N I N A UM A R I A , P E T E R J . G U E S T Department of Clinical Radiology, Queen Elizabeth Hospital, Birmingham, U.K.
Lymphomatous involvement of the kidney occurs in only 2.7±6% of cases of non-Hodgkin's lymphoma at presentation [1,2] and is usually seen in the setting of disseminated disease. A pattern of peripelvic or periureteric lymphoma in the absence of other abdominal disease is particularly rare [3±7]. We report a patient in whom peripelvic and periureteric in®ltration was the only evidence of lymphoma and demonstrate the computed tomography (CT) ®ndings. We present a further patient in whom this unusual pattern of periureteric and peripelvic lymphoma was seen bilaterally and symmetrically at CT, a feature noted on only one previous occasion [6].
normal. CT of the abdomen and pelvis (10-mm contiguous sections with 100 ml of intravenous contrast medium) demonstrated no abdominal or pelvic lymphadenopathy, but a small amount of soft tissue, related to the medial part of the right kidney, and extending around the proximal
CASE REPORTS
Case 1 A 61-year-old man presented with an 18-month history of right eye discomfort and proptosis. There was no lymphadenopathy, hepatosplenomegaly or any other abnormality on physical examination. CT of the orbits revealed an extraconal soft tissue mass in the lateral part of the right orbit. Surgical biopsy of this mass revealed low grade B-cell non-Hodgkin's lymphoma and the patient underwent right orbital radiotherapy (35 Gy in 20 fractions). Staging CT of the abdomen and pelvis (10-mm contiguous sections with 100 ml of intravenous contrast medium) revealed bilateral ¯ame-shaped soft tissue masses surrounding each renal pelvis, and symmetrically encasing the proximal two-thirds of both ureters (Fig. 1). There was no evidence of hydronephrosis. No abdominal or pelvic lymph node enlargement was identi®ed and no parenchymal abnormality was seen in either kidney. Chest radiographs were normal. A CT-guided 18 gauge core biopsy of the left periureteric soft tissue mass demonstrated B-cell non-Hodgkin's lymphoma. One year later, and following six cycles of oral chlorambucil, CT demonstrated complete resolution of the orbital, periureteric and peripelvic soft tissue masses. The patient remains in complete clinical remission 3 years later but has recently had a radiotherapy-induced cataract removed.
Case 2 A 56-year-old man presented with clinical and biochemical features of nephrotic syndrome. A renal biopsy showed early focal segmental glomerulosclerosis with a perinephric small lymphocyte in®ltrate which raised the possibility of non-Hodgkin's lymphoma. Physical examination revealed no lymphadenopathy or hepatosplenomegaly. Haematological investigations and iliac crest bone marrow trephine biopsy were Author for correspondence: Dr Peter J. Guest, Department of Clinical Radiology, Queen Elizabeth Hospital, Birmingham, West Midlands B15 2TH, U.K. Fax: 44 (0) 121 697 8290.
Fig. 1 ± Axial CT scan of case 1 (a) at the level of the renal pelvis in the nephrogram phase of contrast medium enhancement and (b) at the level of the upper ureters, in the excretory phase of contrast medium enhancement, demonstrating bilateral symmetrical soft tissue in®ltration surrounding both renal pelvises and upper ureters.
CASE REPORTS
Fig. 2 ± (a) Initial axial CT of case 2 at the level of the renal pelvis demonstrating a small amount of soft tissue around the renal pelvis and lateral to the kidney, which was attributed to post-biopsy haematoma. (b) Axial CT performed 3 years later, in the excretory phase of contrast medium enhancement, demonstrating an extensive right peripelvic soft tissue mass. right ureter, was noted (Fig. 2a). This was attributed to probable haematoma formation following the recent renal biopsy. The patient remained asymptomatic but, 3 years later, repeat CT of the abdomen and pelvis was performed in view of the previous CT ®ndings. This showed an extensive soft tissue mass surrounding the right renal pelvis and encasing the proximal ureter with lateral displacement of the right lower kidney (Fig. 2b). There was no hydronephrosis and no right renal parenchymal abnormality was demonstrated. There were no enlarged abdominal or pelvic lymph nodes. The chest radiograph was normal. CT-guided 18 gauge core biopsy of the right periureteric mass revealed low grade non-Hodgkin's lymphoma. Serial CT examinations were performed and 1 year later, following six courses of oral chlorambucil, there was almost complete resolution of the right periureteric and peripelvic lymphomatous in®ltrate. The patient remains in clinical and radiological partial remission 2 years later.
DISCUSSION
Patterns of extranodal lymphoma in the genitourinary tract have been clari®ed by the routine use of abdominal CT
423
in staging these tumours. Imaging ®ndings in renal lymphoma include multiple masses, solitary masses, diuse in®ltration, contiguous retroperitoneal disease and perirenal involvement [8±11]. Renal lymphoma occurs much more commonly in non-Hodgkin's lymphoma than Hodgkin's lymphoma. Peripelvic and periureteric patterns of lymphomatous involvement usually occur secondary to extension from renal parenchyma or retroperitoneal adenopathy [5]. On a few occasions they have been described in the absence of renal parenchymal or other abdominal disease [3±8]. However, there has been only one report of possibly isolated peripelvic or periureteric lymphoma [6], with other cases arising together with distant lymphoma sites. The dierential diagnosis of isolated peripelvic or periureteral soft tissue includes lymphoma, metastases ( prostate, colon, stomach, breast, melanoma and lung carcinoma) [12] and retroperitoneal ®brosis. The similarity of CT appearances in our two cases led to lymphoma being suggested as the primary diagnosis in the second patient. Our second case con®rms that lymphomatous in®ltration should remain a possibility even in the absence of other abdominal disease or a previous diagnosis of lymphoma. Typical CT features of genitourinary lymphoma without any other clinical or imaging manifestations of lymphoma is one circumstance in which the diagnosis should be established by percutaneous needle biopsy, and in our patients this allowed for a totally non-surgical approach. It has been noted in the past that ®ne needle aspiration (FNA) is not as accurate for detecting lymphoma as for carcinoma [13], so if image-guided biopsy is to be performed, this consideration may aect the type of needle chosen. As with cases of primary renal lymphoma, appropriate treatment in periureteric and peripelvic lymphoma is with chemotherapy, with or without radiotherapy, depending on histology, stage and volume of disease. It may be that the peripelvic and periureteric lymphoma in case 1 originated via haematogenous seeding from the orbital mass whilst that in case 2 arose de novo. As with primary renal lymphoma, it is dicult to explain the existence of peripelvic and periureteric lymphoma originating de novo since there is no lymphoid tissue in the genitourinary tract. The extension along the ureters and the even concentric growth around the ureters in our cases is consistent with spread along both longitudinally and radially orientated vessels [14]. Since both our cases underwent a histological diagnosis by CT-guided core biopsy, we have no surgical±pathological correlation to con®rm whether there was in®ltration of the ureteric wall itself, in addition to the predominant peripelvic and periureteral involvement. One series of `encased ureters' demonstrated by retrograde ureterography did not include any cases of lymphoma [15] and this suggests a tendency for the lymphoma to in®ltrate around and not impinge on the ureter ± a feature more easily demonstrated by CT than retrograde ureterography. It is particularly rare for the mucosa to be in®ltrated by lymphoma, which may explain why haematuria was not a feature in these or other cases of ureteral or periureteral lymphoma [3,4,6,7] and why ureteral brushings are often unhelpful [4]. The lack of hydronephrosis and the
424
CLINICAL RADIOLOGY
preservation or renal function in our case of bilateral ureteric involvement would also argue against signi®cant invasion of the ureteric wall. This lack of obstruction is striking in view of the bulky disease and may help in dierentiating periureteric lymphomatous in®ltration from retroperitoneal ®brosis or nodal disease. It is interesting that, in the one previous report of isolated periureteric lymphoma [6], there was some limited lymphomatous involvement of the renal parenchyma detected on a renal biopsy, although there was no parenchymal abnormality seen on magnetic resonance imaging, suggesting that there had been some transcapsular spread. The renal biopsy performed at presentation in case 2 did not detect any intrarenal lymphoma, so this represents a proven case of truly isolated peripelvic and periureteric lymphoma. In neither of our cases was there CT evidence of renal parenchymal involvement. It is unlikely that there was occult disease present elsewhere since there was still no evidence of dissemination three years after the lymphoma was initially detected at CT, despite no treatment. It is appreciated that thoracic CT should have ideally been included in the initial staging of both patients, since small volume nodes are likely to be missed on conventional chest radiography and non-Hodgkin's lymphoma is known to spread in a non-contiguous fashion. In summary, CT was useful in detecting primary periureteric and peripelvic lymphoma in one case and in demonstrating an unusual bilateral, symmetrical periureteric and peripelvic distribution of lymphoma in a further case. It also allowed image guided biopsy and was useful in monitoring the response to treatment. This pattern of CT involvement, either unilaterally or bilaterally, without ureteric obstruction and with or without other imaging abnormalities, is suggestive of lymphoma.
REFERENCES 1 Burgener FA, Hamlin DJ. Histiocytic lymphoma of the abdomen: radiographic spectrum. Am J Roentgenol 1981;137:337±342. 2 Ellert J, Kreel L. The role of CT in the initial staging and subsequent management of the lymphomas. J Comput Assist Tomogr 1980;4:369±391. 3 Buck DS, Peterson MAS, Borochovitz D, Bloom EJ. Non-Hodgkin lymphoma of the ureter: CT demonstration with pathologic correlation. Urol Radiol 1992;14:183±187. 4 Chen HH, Panella JS, Rochester D, Ignato JM, McVary KT. Non-Hodgkin lymphoma of the ureteral wall: CT ®ndings. J Comput Assist Tomogr 1988;12:157±158. 5 Hartman DS, Davis CJ Jr, Goldman SM, Friedman AC, Fritzche P. Renal lymphoma: radiologic±pathologic correlation of 21 cases. Radiology 1982;144:759±766. 6 Lebowitz JA, Rofsky NM, Weinreb JC, Friedmann P. Ureteral lymphoma: MRI demonstration. Abdom Imaging 1995;20:173±175. 7 McMillin KI, Gross BH. CT demonstration of peripelvic and periureteral non-Hodgkin lymphoma. Am J Roentgenol 1985;144: 945±946. 8 Charnsangavej C. Lymphoma of the genitourinary tract. Radiol Clin N Am 1990;28:865±877. 9 Sheeran SR, Sussman SK. Renal lymphoma: spectrum of CT ®ndings and potential mimics. Am J Roentgenol 1998;171: 1067±1072. 10 Cohan RH, Dunnick NR, Leder RA, Baker ME. Computed tomography of renal lymphoma. J Comut Assist Tomogr 1994;14: 933±938. 11 Reznek RH, Mootoosamy I, Webb JA, Richards MA. CT in renal and perirenal lymphoma: a further look. Clin Radiol 1990;42: 233±238. 12 Bosniak MA, Megibow AL, Ambos MA, et al. Computed tomography of ureteral obstruction. Am J Roentgenol 1982;138: 1107±1113. 13 Zornoza J, Cabanillas FF, Alto TM, Ordonez N, Cohen MA. Percutaneous needle biopsy in abdominal lymphoma. Am J Roentgenol 1981;136:97±103. 14 Marincek B, Scheidegger JR, Studer UE, Kraft R. Metastatic disease of the ureter: patterns of tumoral spread and radiologic ®ndings. Abdom Imaging 1993;18:88±94. 15 Kunin M, Goodwin WE. The encased ureter: bullet and bodkin pattern, a reliable radiographic sign. Br J Urol 1990;66:471±474.
doi:10.1053/crad.1999.0286, available online at http://www.idealibrary.com on
Transcatheter Embolization of Pseudoaneurysm of the Profunda Femoris Artery Complicating Fracture of the Femoral Neck J A M E S J . E N T W I SL E *, M A R I O DE NU N Z I O{, DAV I D H I N WO O D{ *Department of Radiology, The Glen®eld NHS Trust, Leicester, U.K. and {Department of Radiology, Derbyshire Royal In®rmary, Derby, U.K.
Pseudoaneurysm formation of the profunda femoris artery or its branches is a rare complication following fractures of Author for correspondence: Dr J. J. Entwisle, Department of Radiology, The Glen®eld NHS Trust, Groby Road, Leicester LE3 9QP, U.K.
the femoral neck [1±3]. This may be caused by the initial injury or relate to subsequent internal ®xation [1,2]. Clinical diagnosis may be con®rmed by angiography and treatment simultaneously performed by transcatheter embolization. We describe two cases.
CLINICAL RADIOLOGY
doi:10.1053/crad.1999.0285, available online at http://www.idealibrary.com on
Extranodal Peripelvic and Periureteric Lymphoma ± Demonstration with Computed Tomography S T E P H E N E . J . CO N N O R , N I N A UM A R I A , P E T E R J . G U E S T Department of Clinical Radiology, Queen Elizabeth Hospital, Birmingham, U.K.
Lymphomatous involvement of the kidney occurs in only 2.7±6% of cases of non-Hodgkin's lymphoma at presentation [1,2] and is usually seen in the setting of disseminated disease. A pattern of peripelvic or periureteric lymphoma in the absence of other abdominal disease is particularly rare [3±7]. We report a patient in whom peripelvic and periureteric in®ltration was the only evidence of lymphoma and demonstrate the computed tomography (CT) ®ndings. We present a further patient in whom this unusual pattern of periureteric and peripelvic lymphoma was seen bilaterally and symmetrically at CT, a feature noted on only one previous occasion [6].
normal. CT of the abdomen and pelvis (10-mm contiguous sections with 100 ml of intravenous contrast medium) demonstrated no abdominal or pelvic lymphadenopathy, but a small amount of soft tissue, related to the medial part of the right kidney, and extending around the proximal
CASE REPORTS
Case 1 A 61-year-old man presented with an 18-month history of right eye discomfort and proptosis. There was no lymphadenopathy, hepatosplenomegaly or any other abnormality on physical examination. CT of the orbits revealed an extraconal soft tissue mass in the lateral part of the right orbit. Surgical biopsy of this mass revealed low grade B-cell non-Hodgkin's lymphoma and the patient underwent right orbital radiotherapy (35 Gy in 20 fractions). Staging CT of the abdomen and pelvis (10-mm contiguous sections with 100 ml of intravenous contrast medium) revealed bilateral ¯ame-shaped soft tissue masses surrounding each renal pelvis, and symmetrically encasing the proximal two-thirds of both ureters (Fig. 1). There was no evidence of hydronephrosis. No abdominal or pelvic lymph node enlargement was identi®ed and no parenchymal abnormality was seen in either kidney. Chest radiographs were normal. A CT-guided 18 gauge core biopsy of the left periureteric soft tissue mass demonstrated B-cell non-Hodgkin's lymphoma. One year later, and following six cycles of oral chlorambucil, CT demonstrated complete resolution of the orbital, periureteric and peripelvic soft tissue masses. The patient remains in complete clinical remission 3 years later but has recently had a radiotherapy-induced cataract removed.
Case 2 A 56-year-old man presented with clinical and biochemical features of nephrotic syndrome. A renal biopsy showed early focal segmental glomerulosclerosis with a perinephric small lymphocyte in®ltrate which raised the possibility of non-Hodgkin's lymphoma. Physical examination revealed no lymphadenopathy or hepatosplenomegaly. Haematological investigations and iliac crest bone marrow trephine biopsy were Author for correspondence: Dr Peter J. Guest, Department of Clinical Radiology, Queen Elizabeth Hospital, Birmingham, West Midlands B15 2TH, U.K. Fax: 44 (0) 121 697 8290.
Fig. 1 ± Axial CT scan of case 1 (a) at the level of the renal pelvis in the nephrogram phase of contrast medium enhancement and (b) at the level of the upper ureters, in the excretory phase of contrast medium enhancement, demonstrating bilateral symmetrical soft tissue in®ltration surrounding both renal pelvises and upper ureters.
CASE REPORTS
Fig. 2 ± (a) Initial axial CT of case 2 at the level of the renal pelvis demonstrating a small amount of soft tissue around the renal pelvis and lateral to the kidney, which was attributed to post-biopsy haematoma. (b) Axial CT performed 3 years later, in the excretory phase of contrast medium enhancement, demonstrating an extensive right peripelvic soft tissue mass. right ureter, was noted (Fig. 2a). This was attributed to probable haematoma formation following the recent renal biopsy. The patient remained asymptomatic but, 3 years later, repeat CT of the abdomen and pelvis was performed in view of the previous CT ®ndings. This showed an extensive soft tissue mass surrounding the right renal pelvis and encasing the proximal ureter with lateral displacement of the right lower kidney (Fig. 2b). There was no hydronephrosis and no right renal parenchymal abnormality was demonstrated. There were no enlarged abdominal or pelvic lymph nodes. The chest radiograph was normal. CT-guided 18 gauge core biopsy of the right periureteric mass revealed low grade non-Hodgkin's lymphoma. Serial CT examinations were performed and 1 year later, following six courses of oral chlorambucil, there was almost complete resolution of the right periureteric and peripelvic lymphomatous in®ltrate. The patient remains in clinical and radiological partial remission 2 years later.
DISCUSSION
Patterns of extranodal lymphoma in the genitourinary tract have been clari®ed by the routine use of abdominal CT
423
in staging these tumours. Imaging ®ndings in renal lymphoma include multiple masses, solitary masses, diuse in®ltration, contiguous retroperitoneal disease and perirenal involvement [8±11]. Renal lymphoma occurs much more commonly in non-Hodgkin's lymphoma than Hodgkin's lymphoma. Peripelvic and periureteric patterns of lymphomatous involvement usually occur secondary to extension from renal parenchyma or retroperitoneal adenopathy [5]. On a few occasions they have been described in the absence of renal parenchymal or other abdominal disease [3±8]. However, there has been only one report of possibly isolated peripelvic or periureteric lymphoma [6], with other cases arising together with distant lymphoma sites. The dierential diagnosis of isolated peripelvic or periureteral soft tissue includes lymphoma, metastases ( prostate, colon, stomach, breast, melanoma and lung carcinoma) [12] and retroperitoneal ®brosis. The similarity of CT appearances in our two cases led to lymphoma being suggested as the primary diagnosis in the second patient. Our second case con®rms that lymphomatous in®ltration should remain a possibility even in the absence of other abdominal disease or a previous diagnosis of lymphoma. Typical CT features of genitourinary lymphoma without any other clinical or imaging manifestations of lymphoma is one circumstance in which the diagnosis should be established by percutaneous needle biopsy, and in our patients this allowed for a totally non-surgical approach. It has been noted in the past that ®ne needle aspiration (FNA) is not as accurate for detecting lymphoma as for carcinoma [13], so if image-guided biopsy is to be performed, this consideration may aect the type of needle chosen. As with cases of primary renal lymphoma, appropriate treatment in periureteric and peripelvic lymphoma is with chemotherapy, with or without radiotherapy, depending on histology, stage and volume of disease. It may be that the peripelvic and periureteric lymphoma in case 1 originated via haematogenous seeding from the orbital mass whilst that in case 2 arose de novo. As with primary renal lymphoma, it is dicult to explain the existence of peripelvic and periureteric lymphoma originating de novo since there is no lymphoid tissue in the genitourinary tract. The extension along the ureters and the even concentric growth around the ureters in our cases is consistent with spread along both longitudinally and radially orientated vessels [14]. Since both our cases underwent a histological diagnosis by CT-guided core biopsy, we have no surgical±pathological correlation to con®rm whether there was in®ltration of the ureteric wall itself, in addition to the predominant peripelvic and periureteral involvement. One series of `encased ureters' demonstrated by retrograde ureterography did not include any cases of lymphoma [15] and this suggests a tendency for the lymphoma to in®ltrate around and not impinge on the ureter ± a feature more easily demonstrated by CT than retrograde ureterography. It is particularly rare for the mucosa to be in®ltrated by lymphoma, which may explain why haematuria was not a feature in these or other cases of ureteral or periureteral lymphoma [3,4,6,7] and why ureteral brushings are often unhelpful [4]. The lack of hydronephrosis and the
424
CLINICAL RADIOLOGY
preservation or renal function in our case of bilateral ureteric involvement would also argue against signi®cant invasion of the ureteric wall. This lack of obstruction is striking in view of the bulky disease and may help in dierentiating periureteric lymphomatous in®ltration from retroperitoneal ®brosis or nodal disease. It is interesting that, in the one previous report of isolated periureteric lymphoma [6], there was some limited lymphomatous involvement of the renal parenchyma detected on a renal biopsy, although there was no parenchymal abnormality seen on magnetic resonance imaging, suggesting that there had been some transcapsular spread. The renal biopsy performed at presentation in case 2 did not detect any intrarenal lymphoma, so this represents a proven case of truly isolated peripelvic and periureteric lymphoma. In neither of our cases was there CT evidence of renal parenchymal involvement. It is unlikely that there was occult disease present elsewhere since there was still no evidence of dissemination three years after the lymphoma was initially detected at CT, despite no treatment. It is appreciated that thoracic CT should have ideally been included in the initial staging of both patients, since small volume nodes are likely to be missed on conventional chest radiography and non-Hodgkin's lymphoma is known to spread in a non-contiguous fashion. In summary, CT was useful in detecting primary periureteric and peripelvic lymphoma in one case and in demonstrating an unusual bilateral, symmetrical periureteric and peripelvic distribution of lymphoma in a further case. It also allowed image guided biopsy and was useful in monitoring the response to treatment. This pattern of CT involvement, either unilaterally or bilaterally, without ureteric obstruction and with or without other imaging abnormalities, is suggestive of lymphoma.
REFERENCES 1 Burgener FA, Hamlin DJ. Histiocytic lymphoma of the abdomen: radiographic spectrum. Am J Roentgenol 1981;137:337±342. 2 Ellert J, Kreel L. The role of CT in the initial staging and subsequent management of the lymphomas. J Comput Assist Tomogr 1980;4:369±391. 3 Buck DS, Peterson MAS, Borochovitz D, Bloom EJ. Non-Hodgkin lymphoma of the ureter: CT demonstration with pathologic correlation. Urol Radiol 1992;14:183±187. 4 Chen HH, Panella JS, Rochester D, Ignato JM, McVary KT. Non-Hodgkin lymphoma of the ureteral wall: CT ®ndings. J Comput Assist Tomogr 1988;12:157±158. 5 Hartman DS, Davis CJ Jr, Goldman SM, Friedman AC, Fritzche P. Renal lymphoma: radiologic±pathologic correlation of 21 cases. Radiology 1982;144:759±766. 6 Lebowitz JA, Rofsky NM, Weinreb JC, Friedmann P. Ureteral lymphoma: MRI demonstration. Abdom Imaging 1995;20:173±175. 7 McMillin KI, Gross BH. CT demonstration of peripelvic and periureteral non-Hodgkin lymphoma. Am J Roentgenol 1985;144: 945±946. 8 Charnsangavej C. Lymphoma of the genitourinary tract. Radiol Clin N Am 1990;28:865±877. 9 Sheeran SR, Sussman SK. Renal lymphoma: spectrum of CT ®ndings and potential mimics. Am J Roentgenol 1998;171: 1067±1072. 10 Cohan RH, Dunnick NR, Leder RA, Baker ME. Computed tomography of renal lymphoma. J Comut Assist Tomogr 1994;14: 933±938. 11 Reznek RH, Mootoosamy I, Webb JA, Richards MA. CT in renal and perirenal lymphoma: a further look. Clin Radiol 1990;42: 233±238. 12 Bosniak MA, Megibow AL, Ambos MA, et al. Computed tomography of ureteral obstruction. Am J Roentgenol 1982;138: 1107±1113. 13 Zornoza J, Cabanillas FF, Alto TM, Ordonez N, Cohen MA. Percutaneous needle biopsy in abdominal lymphoma. Am J Roentgenol 1981;136:97±103. 14 Marincek B, Scheidegger JR, Studer UE, Kraft R. Metastatic disease of the ureter: patterns of tumoral spread and radiologic ®ndings. Abdom Imaging 1993;18:88±94. 15 Kunin M, Goodwin WE. The encased ureter: bullet and bodkin pattern, a reliable radiographic sign. Br J Urol 1990;66:471±474.
doi:10.1053/crad.1999.0286, available online at http://www.idealibrary.com on
Transcatheter Embolization of Pseudoaneurysm of the Profunda Femoris Artery Complicating Fracture of the Femoral Neck J A M E S J . E N T W I SL E *, M A R I O DE NU N Z I O{, DAV I D H I N WO O D{ *Department of Radiology, The Glen®eld NHS Trust, Leicester, U.K. and {Department of Radiology, Derbyshire Royal In®rmary, Derby, U.K.
Pseudoaneurysm formation of the profunda femoris artery or its branches is a rare complication following fractures of Author for correspondence: Dr J. J. Entwisle, Department of Radiology, The Glen®eld NHS Trust, Groby Road, Leicester LE3 9QP, U.K.
the femoral neck [1±3]. This may be caused by the initial injury or relate to subsequent internal ®xation [1,2]. Clinical diagnosis may be con®rmed by angiography and treatment simultaneously performed by transcatheter embolization. We describe two cases.