Post-Traumatic Pseudoaneurysm of Common Digital Artery of Superficial Palmar Arch- A Curious Case with Critical Complexities

Download Article

DOI: 10.21522/TIJPH.2013.12.04.Art055

Authors : Manimaran, Arjun Aravindh R R, Karthikeyan, Sasikumar

Abstract:

Pseudoaneurysm is an extremely rare condition but poses significant challenges in early diagnosis and can lead to devastating complications if untreated. Pseudoaneurysm is defined as the dilation of the arterial wall caused by disruption of the vessel wall leading to extravasation of blood into a false sac that has communication with the vessel lumen. True aneurysm is formed by all three layers of the arterial wall while pseudoaneurysm is formed by tunica adventitia. Trauma is the most common cause of pseudoaneurysms. It is a rare entity but with significant complications such as thrombosis, embolism and compression of nerves and veins. Here we bring up a case of a twenty-one-year-old male who presented with swelling over his left hand below 2nd web space following a fire crack injury which was associated with pain, restriction of movement and numbness over his left middle finger. The swelling was found to be well-defined, pulsatile, compressible, and cystic in consistency with palpable thrill and systolic bruit on auscultation. Doppler ultrasound showed a cystic lesion with characteristic yin-yang flow. A diagnosis of possible partially thrombosed post-traumatic pseudoaneurysm was made. Surgical ligation with excision under regional anaesthesia was done. Histopathological examination confirmed the diagnosis of pseudoaneurysm. The patient made a full recovery with no post-operative complications. This emphasizes the importance of early diagnosis and management of pseudoaneurysm. Also, this reinvigorates surgical management as the gold standard treatment.

References:

[1].  Schoretsanitis, N., Moustafa, E., Beropoulis, E., Argyriou, C., Georgiadis, G. S., Georgakarakos, E, 2015, Traumatic Pseudoaneurysm of the Superficial Palmar Arch: A Case Report and Review of the Literature. J Hand Microsurg. Jun;7(1):230-2. https://doi.org/10.1007/12593-015-0183-5

[2].  Fields, J. M., Chandra, S., Au, A. K., Rotte, M., Ku, B. S., 2013, Images in emergency medicine. Child with painful palmar mass. Superficial palmar arch pseudoaneurysm. Ann Emerg Med.;62(6):569-577. https://doi.org/10.1016/j.annemergmed.2013.05.007

[3].  Maertens, A., Tchoungui Ritz, F. J., Poumellec, M. A., Camuzard, O., Balaguer, T., 2020, Posttraumatic pseudoaneurysm of a superficial branch of the ulnar artery: A case report. Int J Surg Case Rep. 75:317-321. https://doi.org/10.1016/j.ijscr.2020.09.029

[4].  Dell'Orfano, M., Milella, F. M., Braidotti, P., 2023, Radial artery pseudoaneurysm following wrist trauma. A case report of a rare condition. Trauma Case Rep 6; 44:100783. https://doi.org/10.1016/j.tcr.2023.100783

[5].  Gull, S., Spence, R. A., Loan, W., 2011, Superficial palmar arch aneurysm after carpal tunnel decompression, a rare complication: a case report. Case Rep Med. 2011:595120. https://doi.org/10.1155/2011/595120

[6].  Zitsman, J. L., 1998, Pseudoaneurysm after penetrating trauma in children and adolescents. J Pediatr Surg.;33(10):1574-1577. https://doi.org/10.1016/s0022-3468(98)90504-8

[7].  Sakamoto, A., Arai, K., 2009, False aneurysm of the superficial palmar arch in a child: A case report. Cases J. 2009 Jul 24; 2:7985. https://doi.org/10.4076%2F1757-1626-2-7985

[8].  Kwiecien, G. J., Garbuzov, A., Boonipat, T., Houdek, M. T., Moran, S. L., 2022, Pseudoaneurysm of the Superficial Palmar Arch in a 6-month-old Child: A Case Report. Plast Reconstr Surg Glob Open;10(2): e4093. https://doi.org/10.1097%2FGOX.0000000000004093

[9].  Corvino, A., Catalano, O., de Magistris, G., Corvino, F., Giurazza, F., Raffaella, N., Vallone, G., 2020, Usefulness of doppler techniques in the diagnosis of peripheral iatrogenic pseudoaneurysms secondary to minimally invasive interventional and surgical procedures: Imaging findings and diagnostic performance study. J Ultrasound, 23(4):563-573. https://doi.org/10.1007/s40477-020-00475-6

[10]. Papatheodorou, N., Dimitriadis, K., Doukas, D., Argyriou, C., Georgiadis, G. S., 2022, Surgical Reconstruction of Traumatic Pseudoaneurysm of Palmar Arch Caused by Blunt Trauma. Vasc Specialist Int 13; 38: 30. https://doi.org/10.5758/vsi.220031

[11]. Yadav, R., Sharma, A., Pathak, S., 2023, Successful Surgical Management of Post-traumatic Superficial Femoral Artery Pseudoaneurysm with Delayed Presentation. Cureus. 15(9):e45739. https://doi.org/10.7759/cureus.45739

[12]. Mahmoud, M. Z., Al-Saadi, M., Abuderman, A., et al, 2015, "To-and-fro" waveform in the diagnosis of arterial pseudoaneurysms. World Journal of Radiology.7(5):89-99. https://doi.org/10.4329/wjr.v7.i5.89

[13]. Igari, K., Kudo, T., Toyofuku., T, Jibiki, M., Inoue, Y., 2013, Surgical treatment of aneurysms in the upper limbs. Ann Vasc Dis;6(3):637-41. https://doi.org/10.3400/avd.cr.13-00024

[14]. Woodley-Cook, J., Konieczny, M., Simons, M., 2015, The ulnar artery pseudoaneurysm. BMJ Case Rep. 2015 Oct 6;2015: https://doi.org/10.1136/bcr-2015-212791

[15]. Cozzi, D. A., Morini, F., Casati, A., Pacilli, M., Salvini, V., Cozzi, F., 2013, Radial artery pseudoaneurysm successfully treated by compression bandage. Arch Dis Child.;88(2):165-166. https://doi.org/10.1136/adc.88.2.165

[16]. Muir, H., Cowan, K., Steele, P., Downie, J. J., 2021, Presentation and surgical management of a superficial temporal artery pseudoaneurysm: A case report. Int J Surg Case Rep. 79:368-370. https://doi.org/10.1016/j.ijscr.2021.01.072

[17]. Wang, Y., Zheng, H., Yao, W., Ju, S., Bai, Y., Wang, C., Zhou, C., Liu, J., Yang, C., Huang, S., Li, T., Chen, Y., Xiong, B., 2022, Management of traumatic peripheral artery pseudoaneurysm: A 10-year experience at a single center. J Interv Med;6(1):29-34. https://doi.org/10.1016/j.jimed.2022.10.002

[18]. Shreve, L., Jarmakani, M., Javan, H., Babin, I., Nelson, K., Katrivesis, J., Lekawa, M., Kuncir, E., Fernando, D., Abi-Jaoudeh, N., 2020, Endovascular management of traumatic pseudoaneurysms. CVIR Endovasc;3(1):88. https://doi.org/10.1186/s42155-020-00182-7

[19]. Saydam, O., Serefli, D., Engin, A. Y., Atay, M., 2020, Ultrasound-guided thrombin injection for treatment of iatrogenic femoral artery pseudoaneurysms compared with open surgery: First experiences from a single institution. Ann Surg Treat Res. 98(5):270-276. https://doi.org/10.4174/astr.2020.98.5.270

[20]. Hughes, C. D., Binette, C., Babigian, A., 2012, Pseudoaneurysm in the hand of a three-year-old boy: A case report. J Emerg Med. 42(4):e87-e89. https://doi.org/10.1016/j.jemermed.2010.11.049

[21]. Lucchina, S., Nistor, A., Stricker, H., Fusetti, C., 2011, False aneurysm of the common digital artery. Is reconstruction with an arterial graft worth the efforts? A case report. Microsurgery.;31(3):246-250. http://doi.org/10.1002/micr.20872

[22]. Ferreira, V., Matos, A., Rego, D., et al., 2017, Percutaneous Treatment Pseudo-Aneurism of the Hand in Hemophilic Patient. Rev Port Cir Cardiotorac Vasc.;24(3-4):178.

[23]. Cromheecke, M., van Straalen, A. M., Damen, A., 1997, Traumatic aneurysm of a common digital artery. J Hand Surg Br.;22(3):416-418. http://doi:10.1016/s0266-7681(97)80417-2