Pulsatile mass: The importance of phsysical examination

Abstract text (incl. references and figure legends)

A 93-year-old woman was presented to our emergency department with swelling of the forehead 8 months after head blunt trauma. A pulsatile mass with a diameter of 2 cm, with an area of superficial necrosis was observed. Doppler ultrassonography revealed a pseudoaneurysm of the right superficial temporal artery. Under local anesthesia, the false aneurysm was removed, and the superficial temporal artery was ligated.

The most likely diagnosis of a swelling after blunt trauma is a hematoma. Pseudoaneurysms are more associated with iatrogenic trauma after invasive vascular procedures.

Superficial temporal artery pseudoaneurysm is a rare presentation of swelling after blunt trauma, with a limited number of cases described on literature. Many misdiagnoses as hematomas, if left untreated, it may rupture and can cause a life-threatening hemorrhage leading to hemodynamic instability.

Surgical ligation and resection is the treatment of choice, and alternative therapies such as ultrasound-guided compression therapy and ultrasound-guided thrombin injection are an option in smaller masses.

Thus, a cautious phsysical examination associated with a high index of suspicion is essential for an accurate differential diagnosis.

Fig. 1 Doppler ultrasonography showing the characteristic to-and-fro curve

Fig. 2 Excision was performed followed by ligation of the proximal and distal ends in the lesion

Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.)

No