A post-traumatic pulsatile nodule in the right pre-auricular region

• Published in: BMJ (Online) 2015-03, Vol.350 (mar24 3), p.h1441-h1441
• Main Authors: Skelton, Emily, Moody, Andrew B, Anderson, Hugh J, Howlett, David C
• Format: Article
• Language: English
• Subjects: Aneurysm, False - diagnostic imaging; Aneurysm, False - etiology; Carotid arteries; CASE REVIEW; Cysts; Defects; Humans; Male; Medical imaging; Middle Aged; Temporal Arteries - diagnostic imaging; Temporal Arteries - injuries; Thrombosis; Tomography; Ultrasonic imaging; Ultrasonography, Doppler, Color; Vascular System Injuries - complications; Veins & arteries
• ISSN: 0959-8138; 1756-1833; 1756-1833
• DOI: 10.1136/bmj.h1441

The capsule expands, and the haematoma is absorbed, leaving a cavity, which is connected to the main artery through a neck-the pseudoaneurysm. 2 Pseudoaneurysms of the superficial temporal artery are rare, with fewer than 200 cases reported in the literature. 3 They can present to a variety of specialties because they are caused by a wide range of injury processes, including blunt trauma, sporting injuries, falls, and even hair transplantation. 4 Patients typically present with a compressible pulsatile mass two to four weeks after trauma. A case of induced seizure and ischaemia of the scalp has been attributed to the migration of injected thrombin after percutaneous thrombin injection for a pseudoaneurysm of the superficial temporal artery. 17 Other complications include allergic reaction and risk of recanalisation of the pseudoaneurysm. 18 Surgical ligation and excision has now largely been replaced by newer techniques, although it may still be used as a reserve treatment when initial attempts at micro-coil embolisation have failed, or as an alternative approach in patients with contraindications to endovascular intervention (such as allergies to iodinated contrast).