Pseudoaneurysm in the hand of a three-year-old boy: a case report

Nontraumatic Pseudoaneurysm of the Deep Palmar Arch in a 10-Month-Old Infant: A Case Report

CASE

Pseudoaneurysms of the hand are rare among the adult population and even more rare in pediatric patients. We report a case of a 10-month-old boy who presented with a nontraumatic pseudoaneurysm of the deep palmar arch, likely of congenital etiology. Magnetic resonance imaging and angiography identified the growing left hand palmar mass. Surgical excision without the need for vascular reconstruction was performed successfully with no recurrence or complications at 1-year follow-up.

CONCLUSION

Surgical excision is an effective treatment for large or symptomatic palmar pseudoaneurysms of likely congenital origin. Vascular reconstruction after excision must be considered on a case-by-case basis to ensure adequate hand perfusion.

Management of traumatic superficial palmar arch pseudoaneurysm: a therapeutic challenge

Pseudoaneurysm of the palmar arch is a rare entity. Diagnosis is dependent on high clinical suspicion. We present a case referred to the emergency department, with a history of glass penetrating trauma to the palmar surface with a pulsatile mass and jet bleeding. Doppler ultrasound evidenced a partially thrombosed pseudoaneurysm. A CT angiography examination showed a saccular formation arising from the superficial palmar arch. A conventional surgical approach was indicated. A clinical suspicion must be ventured to arrive at the correct diagnosis. Imaging modalities are needed to identify the pseudoaneurysm and plan the treatment course. Nonetheless, the sequence of diagnosis is individual, because further evaluation with different imaging methods may not change the rationale for the intervention. In our experience, conventional surgical removal is preferable, due to its safety and well-established outcomes.

Ultrasonography in the assessment of hand injuries in children: A systematic review

Despite the frequency of paediatric hand injuries, recommendations for diagnostic investigations are limited due to paucity of published guidelines. This has led to inappropriate diagnoses and therefore inappropriate management. Ultrasonography is a portable, non-ionising imaging modality that allows rapid real-time evaluation of anatomical structures at a low cost and without sedation. In the adult population, ultrasonography has already been shown to improve accuracy in hand injury diagnoses. However, in the paediatric population, only one narrative review focuses on the application of ultrasonography to diagnose hand injury. A systematic search using PubMed, Google Scholar, EMBASE, Scopus, Cochrane database of systematic reviews and University Library of York, Keele, Edinburgh and King's College London was conducted to assess literature surrounding use of ultrasonography as a diagnostic tool for paediatric hand injuries. The literature search yielded 11,860 articles and 21 studies were identified with a total of 30 patients. Ultrasonography was observed to be an accurate tool for diagnosing bone, tendon, ligament and nerve injuries in children. The results of our study suggest that ultrasonography should be considered as an early diagnostic step for paediatric hand injuries.

Surgical Reconstruction of Traumatic Pseudoaneurysm of Palmar Arch Caused by Blunt Trauma

Although rare, pseudoaneurysms (PAs) of the palmar arch are mostly considered benign. However, they can cause severe complications if left untreated or misdiagnosed. There are a few data on traumatic PAs of the palmar arch, particularly those most commonly caused by penetrating hand injuries. However, PAs caused by blunt trauma are more insidious in onset, presenting as a painful pulsatile mass in the palmar area of the hand, and require prompt diagnosis and management to avoid catastrophic sequelae. Our case is the first study to describe a patient with traumatic PA of the palmar arch caused by blunt trauma that was treated with surgical reconstruction and venous bypass interposition.

Unusual Combination of a Fracture Monteggia Equivalent With Post-traumatic Radial Artery Pseudoaneurysm in a Child: A Case Report and Review of Literature

CASE

We report a unique case of a combination of forearm fracture and traumatic radial artery pseudoaneurysm in an 8-year-old child. The fracture pattern was a Monteggia equivalent with a mid-diaphyseal ulnar fracture and a radial neck fracture with displacement of the distal radial diaphyseal fracture fragment. The pseudoaneurysm, which probably developed after vigorous manipulation by a bonesetter, thrombosed spontaneously, and the fracture was managed nonoperatively with a good outcome.

CONCLUSION

Pseudoaneurysm of the radial artery is a rare phenomenon associated with fracture in a child. A history of vigorous manipulation of displaced fracture fragments in the vicinity of a major vessel should raise suspicion of this possible complication.

A Rare Pediatric Case of Posttraumatic Pseudoaneurysm: Case Report and Literature Review

Posttraumatic pseudoaneurysms are extremely rare in pediatric populations. In many cases, pseudoaneurysms may be confused with abscesses, epidermoid cysts, arteriovenous fistula, foreign objects, and ganglion cysts, as well as tumors. They are associated with distinguishing findings of "pulsatile mass, a palpable thrill, and an audible to-and-fro murmur" (1), which can be confirmed by various imaging techniques. In this report, we describe the case of a 4-year-old boy who presented to the pediatric emergency department 3 weeks after falling and subsequently getting cut by glass. Upon clinical examination, the patient presented with pulsatile, swollen mass in the left wrist. A Doppler ultrasound of the left wrist demonstrated that the area of clinical concern in the left wrist showed a pseudoaneurysm, and prominent arterial blood flow was seen within the pseudoaneurysm. Because pseudoaneurysms, particularly posttraumatic pseudoaneurysms, are extremely rare in the pediatric population, it may be easy to miss these cases during clinical examination. Misdiagnosis of the pseudoaneurysm can cause delayed treatment, a longer recovery period, and complications such as infection, rupture, and hemorrhage. It is important for physicians to consider this entity when evaluating patients with symptoms of asymptomatic bulges to painful pulsatile masses after trauma.

Development of an iatrogenic aneurysm nine months after pacemaker implantation: Consideration of causes and treatment

Careful technique is required in pacemaker implantation to avoid serious iatrogenic complications. A 70-year-old woman on an anticoagulant agent underwent pacemaker implantation. Nine months after implantation, a 35-mm pulsatile mass appeared just near the cranial edge of the generator. An iatrogenic pseudoaneurysm was suspected because ultrasonography showed communication with the blood stream through tiny artery. The resected mass proved to be a pseudoaneurysm. This was a rare case of iatrogenic delayed pseudoaneurysm appearing nine months later. It is essential to keep in mind the risk of pseudoaneurysm after pacemaker implantation, especially when the patient takes anticoagulant agents. <Learning objective: Iatrogenic delayed pseudoaneurysm might develop after pacemaker implantation. It is essential to avoid risk factors for a pseudoaneurysm after pacemaker implantation when the patient is taking anticoagulant agents and to keep in mind careful follow-up even after discharge. Prospective measures such as suspension of antithrombotic agents, minimizing puncture attempts, and wound compression are also important.>.

A Pseudoaneurysm of the Deep Palmar Arch After Penetrating Trauma to the Hand: Successful Exclusion by Ultrasound Guided Percutaneous Thrombin Injection

Introduction

Pseudoaneurysm of the hand is a rare condition; most are treated surgically. Ultrasound guided thrombin injection has not previously been reported as a treatment option for pseudoaneurysms of the deep palmar arch.

Report

A man was referred to the emergency department with a swollen, painful hand after penetrating trauma. On physical examination, a pulsating tumor was found on the dorsum of the hand. Imaging revealed a pseudoaneurysm vascularized by the deep palmar arch. Ultrasound guided percutaneous thrombin injection was successfully performed.

Conclusion

Thrombin injection might be a safe alternative option in the treatment of pseudoaneurysm of the deep palmar arch.

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Pseudoaneurysms of the deep palmar arch are infrequently diagnosed or described in literature.

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Current medical literature describes surgery as the preferred treatment option.

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US-guided percutaneous thrombin injection is a safe alternative option in the treatment of deep palmar arch pseudoaneurysms.