(P105) Pseudoaneurysm Secondary to Frequent IV Drug Use

Chief Complaint : Groin abscess (bounce back)

History of Present Illness : 32-year-old female with past medical history of IVDU presents to the ED complaining of multiple abscesses for the past few weeks. Pt was here last week for neck and groin abscess. Admitted for further work up and IV abx. Normally injects cocaine and fentanyl (usually around 36 bags a day). Since leaving AMA last week now returning with worsening symptoms. L groin abscess burst open and has been bleeding.
Notes it "burst open" 3x today where she just noted a lot of blood but no pus.

Pertinent Physical Exam: Cardiovascular: Regular rhythm. Tachycardia present.
 Skin: Skin is warm and dry. Abscess noted. She is not diaphoretic. There is erythema.
Neck abscesses in multiple areas
L femoral/inguinal area with pulsating mass, surrounding erythema and tenderness
Please see media

Pertinent Laboratory Data: WBC: 31.2; Hgb 7.0 (down from 10 - 1 week ago), Plt: 527; Bands 2%;Trop HS: 76
Blood cx: staph aureus, MRSA; lactate 4.7; Cr. 1.17; Na 133; K 3.3; Cl 96;

Case Discussion: 32 y.o. female with a past medical history of opioid use disorder who presented with left groin bleeding. Patient stated that she uses 2 bundles daily and frequently injected into her neck, arms and groin. Patient stated that she last injected into her left groin two weeks ago and she developed mass after. The mass continued to increase in size and developed pulsatile bleeding one week ago. She stated that then the skin became necrotic and had two large episodes of bleeding before she presented to the ED. On arrival to the ED she was tachypneic and complaining of shortness of breath. CT scan of pelvis showed large soft tissue mass in the left groin with pseudoaneurysm from the left common femoral artery with degeneration of the CFA without contrast extravasation and additionally there were multiple abscesses seen. She underwent CT of neck which demonstrated multiple abscesses within the subcutaneous tissue. Repeat hemoglobin prior to patient going to OR was 5.6. Patient received 2 units preop and another additional unit before going to the OR. Patient was then taken to the OR where she underwent left external iliac artery exposure for proximal control, repair of left common femoral pseudoaneurysm with ePTFE graft and four compartment fasciotomies.

References and Acknowledgements (Optional): To be included