Giant leaking pseudoaneurysm in an intravenous drug user

Abstract

In many low- and middle-income countries, unsafe intravenous drug use is common, and patients often present with thigh lesions that resemble infected abscesses. Repeated trauma to the femoral artery during injections into the femoral vein can lead to the formation of infected pseudoaneurysms, which users sometimes exploit as large “ports” for easier drug administration. These lesions typically come to medical attention only once they begin to leak. By that stage, the surrounding soft-tissue infection and active bleeding make primary excision and reconstruction unfeasible. Definitive management therefore requires urgent wide local debridement and high ligation of the affected vessels.