Doppler sonographic demonstration of the progressive spontaneous thrombosis of pseudoaneurysms

In three patients with diagnosed pseudoaneurysms, surgical intervention was delayed because of the patients' clinical condition. In successive follow-up examinations in one patient, development of a new lobe to the previously single-lobed pseudoaneurysm was noted with progressive centripetal thrombus formation in each lobe leading to the eventual complete thrombosis of the pseudoaneurysm without surgical intervention. The sequence of steps leading to the complete thrombosis of the pseudoaneurysm as seen by color Doppler and pulsed Doppler examination is described. In two other patients with a single-lobed and a multilobed pseudoaneurysm, respectively, follow-up examinations without surgical management revealed complete thrombosis of the pseudoaneurysms. Whereas traditional teaching holds that pseudoaneurysms require surgical repair, this short series of cases suggests that, when progressive centripetal thrombus formation is observed, the pseudoaneurysms can go on to complete thrombosis. Follow-up for up to 4 months reveals no sonographic evidence of rebleeding or other evidence of weakness in the arterial wall at the site of the previous pseudoaneurysms.