Radial Artery Pseudoaneurysm with Aberrant Radial Artery Anatomy: An Unusual Presentation of Flexor Tenosynovitis.

Purpose Radial artery pseudoaneurysm is uncommon and mainly associated with radial artery cannulization for cardiac intervention or invasive hemodynamic monitoring. It is rarely seen as a result of intra-arterial recreational drug injection. Methods We present the case of a 35-year-old man with a 12-year history of intravenous drug use and 1-year history of intra-arterial drug use who developed radial artery pseudoaneurysm with a right long finger suppurative flexor tenosynovitis and subsequent acute radial-sided hand ischemia. Computed tomography (CT) angiography with three-dimensional reconstructions was used in diagnosis. We treated him with parenteral antibiotics followed by surgical debridement of his infection and removal of the infected pseudoaneurysm. Results Examination of the three-dimensional CT angiogram showed an unusual anatomical variant that likely predisposed him to isolated long finger flexor tenosynovitis. Conclusion Prompt diagnosis and treatment of pseudoaneurysm in this context is crucial to avoiding sepsis, hemorrhage, and irreversible ischemia. In rare cases, imaging can demonstrate an underlying anatomical variant that may be a predisposing factor.