Disclosures: Jennifer B. Murphy, DO, MS: No financial relationships or conflicts of interest

Case Diagnosis: Mycotic femoral artery pseudoaneurysm rupture

Case Description: A 66 year old male patient with no significant past medical history was diagnosed with acute Streptococcus mitis mitral valve endocarditis at the acute care hospital. He was also found to have a subarachnoid hemorrhage secondary to mycotic aneurysm rupture which was coiled by neurosurgery. He was transferred to acute rehab after being medically stabilized and there developed acute onset of severe right hip pain while transferring with assistance. He had plain films done which were unremarkable and then quickly developed significant swelling in his right thigh with uncontrollable pain. He was sent back to the acute care hospital for advanced imaging and was found to have a ruptured and actively bleeding femoral artery pseudoaneurysm.

Setting: Acute inpatient rehabilitation hospitalAssessment/

Results: Computed tomography (CT) abdomen/pelvis with runoff revealed ruptured and actively bleeding femoral artery pseudoaneurysm. He was admitted for coiling and embolization by Interventional Radiology (IR). The patient was able to discharge to home without extending course of antibiotics.

Discussion: Mycotic aneurysms are a known sequela of bacterial endocarditis. They are seen frequently in the rehab setting if they have ruptured in the intracerebral vasculature causing a subarachnoid hemorrhage. Typically during rehab, acute hip pain will be musculoskeletal in nature, but this case serves as a reminder to broaden one’s differential diagnosis and consider all the medical co-morbidities of a patient as part of a workup. If this diagnosis were to be missed, it could lead to limb loss or even death.

Conclusion: Here we present a unique case of acute hip pain in the rehabilitation setting that should be considered for patients who have known endocarditis or who have had recent femoral artery access that could have led to a pseudoaneurysm rupture.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/acute-femoral-artery-rupture-in-infective-endocarditis-a-case-report/