Sterile granuloma following transradial catheterization

A 29-year-old Hispanic male with a history of hypertension and mitral valve replacement presented with an acute coronary syndrome. He underwent diagnostic coronary angiography through the right radial approach using a 6 Fr 25-cm long Terumo hydrophilic-coated Glidesheath™. Two weeks later, he presented with a violaceous, non-pulsatile, papulonodular lesion at the radial access site (Panel A). Radial pulses were normal and symmetric with normal capillary refill. The lesion spontaneously resolved in 3 weeks after local wound care and warm compresses (Panel B).

Panel A Panel B

Sterile granulomas at the radial access site have been reported mostly with hydrophilic-coated Cook radial sheaths; however, this complication is very rare with the use of hydrophilic-coated Terumo Glidesheaths. ¹ It typically presents 2–3 weeks after catheterization and is most likely due to a local reaction to an intrinsic component of the hydrophilic coating. Sterile granulomas commonly respond to conservative management, with spontaneous resolution, and rarely require surgical excision and drainage. ²

‘Images in vascular medicine’ is a regular feature of Vascular Medicine. Readers may submit original, unpublished images related to clinical vascular medicine. Submissions may be sent to: Heather L Gornik, Editor in Chief, Vascular Medicine, via the web-based submission system at http://mc.manuscriptcentral.com/vascular-medicine