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Pseudoaneurysm of the Superficial Temporal Artery After Blunt Trauma

      A woman in her mid-80s presented to the emergency department because of progressive increase in volume of a subcutaneous frontal hematoma (Figure 1). This hematoma had initially appeared 6 weeks earlier, following a fall resulting in direct facial trauma.
      Figure thumbnail gr1
      Figure 1Right frontal subcutaneous hematoma.
      An ultrasound was performed and showed a 1.5-cm anechoic formation within the hematoma, in contact with a frontal branch of the superficial temporal artery (STA). This lesion was pulsatile, with blood flow circulating in it ("Yin-Yang" sign) and corresponded to a false aneurysm (Figure 2A–C). She was successfully treated by selective embolization of the supplying artery (Figure 2D).
      Figure thumbnail gr2
      Figure 2(A) Ultrasonography revealing a 1.5-cm anechoic formation within the hematoma. (B,C) Doppler ultrasonography demonstrating direct communication with the frontal branch of the superficial temporal artery and turbulent flow ("Yin-Yang" sign). (D) Angiography showing the pseudoaneurysm of a frontal branch of the superficial temporal artery (yellow arrow).
      False aneurysm (or pseudoaneurysm) occurs after localized rupture of the vascular wall. It consists of a pocket of blood communicating with the injured vessel, contained by the adjacent tissues.
      • Walker M.
      • Liu B.
      • Salehi S.
      • Badve S.
      • Badjer Hunt H.
      Superficial temporal artery pseudoaneurysm: diagnosis and preoperative planning with CT angiography.
      The false aneurysm of the STA is rare, the main etiology being blunt trauma of the face.
      • Walker M.
      • Liu B.
      • Salehi S.
      • Badve S.
      • Badjer Hunt H.
      Superficial temporal artery pseudoaneurysm: diagnosis and preoperative planning with CT angiography.
      The frontal branch of STA is most commonly affected because of its superficial path and proximity to the underlying bone structures.
      • Walker M.
      • Liu B.
      • Salehi S.
      • Badve S.
      • Badjer Hunt H.
      Superficial temporal artery pseudoaneurysm: diagnosis and preoperative planning with CT angiography.
      • Stapleton C.
      • Fusco M.
      • Thomas A.
      • Levy E.
      • Ogilvy S.
      Traumatic pseudoaneurysms of the superficial temporal artery: case series, anatomy, and multidisciplinary treatment consideration.
      • Carnevale M.
      • Phair J.
      • Trestman E.
      • Gregrory D.
      • Vitti M.
      Superficial temporal artery pseudoaneurysm following a traumatic haircut: case report.
      The most common clinical manifestation is a nonpainful pulsatile mass, with headache or discomfort in the ear. False aneurysms usually occur 2 to 12 weeks after the initial injury.
      • Carnevale M.
      • Phair J.
      • Trestman E.
      • Gregrory D.
      • Vitti M.
      Superficial temporal artery pseudoaneurysm following a traumatic haircut: case report.
      Doppler ultrasound is the first-line examination to confirm the diagnosis. Computed tomography and magnetic resonance imaging can also be useful. Angiography is an invasive examination and should be performed for therapeutic purposes.
      • Walker M.
      • Liu B.
      • Salehi S.
      • Badve S.
      • Badjer Hunt H.
      Superficial temporal artery pseudoaneurysm: diagnosis and preoperative planning with CT angiography.
      ,
      • Stapleton C.
      • Fusco M.
      • Thomas A.
      • Levy E.
      • Ogilvy S.
      Traumatic pseudoaneurysms of the superficial temporal artery: case series, anatomy, and multidisciplinary treatment consideration.
      Surgical resection of the pseudoaneurysm of the STA is the treatment of first choice. Embolization can also be made available. Conservative therapies (compression) are not recommended.
      • Stapleton C.
      • Fusco M.
      • Thomas A.
      • Levy E.
      • Ogilvy S.
      Traumatic pseudoaneurysms of the superficial temporal artery: case series, anatomy, and multidisciplinary treatment consideration.

      References

        • Walker M.
        • Liu B.
        • Salehi S.
        • Badve S.
        • Badjer Hunt H.
        Superficial temporal artery pseudoaneurysm: diagnosis and preoperative planning with CT angiography.
        Am J Neuroradiol. 2003; 24: 147-150
        • Stapleton C.
        • Fusco M.
        • Thomas A.
        • Levy E.
        • Ogilvy S.
        Traumatic pseudoaneurysms of the superficial temporal artery: case series, anatomy, and multidisciplinary treatment consideration.
        J Clin Neurosci. 2014; 21: 1529-1532
        • Carnevale M.
        • Phair J.
        • Trestman E.
        • Gregrory D.
        • Vitti M.
        Superficial temporal artery pseudoaneurysm following a traumatic haircut: case report.
        Int Arch Vasc Med. 2018; 1: 1-3