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Chronic posttraumatic pseudoaneurysms of the thoracic aorta are rare clinical entities. Herein, we report a case of an in-hospital cervical rupture of a chronic posttraumatic false aneurysm of the aortic isthmus in a 48-year-old man who had been involved in a traffic accident 20 years earlier.

Introduction and importance Penetrating chest trauma caused by a crossbow bolt is very rare. Herein, we report a successfully treated patient who attempted suicide by directing a crossbow to the chest cavity and developed an expanding pseudoaneurysm of the thoracic aorta during eight-day follow up. Case presentation A 51-year-old male was admitted to the emergency department after firing a crossbow bolt twice into his left chest. At admission, the patient was hemodynamically stable and maintaining oxygenation. The bolt had already been removed from the body. Contrast-enhanced computed tomography (CT) revealed a cavity pseudoaneurysm 2.5 mm in size in the aortic arch. Three-dimensional reconstruction of the CT demonstrated wound tracts showing probable damage by the bolt. The patient was admitted to the emergency department for careful observation and transferred to the psychiatric ward on day two. Follow-up contrast-enhanced CT on day eight demonstrated rapid expansion of the pseudoaneurysm from 2.5 mm to 4.0 mm in size. We performed thoracic endovascular aortic repair (TEVAR) on day 13. The patient was uneventfully discharged on the 20th hospital day. Clinical discussion Emergency physicians should be aware that damage to the surrounding tissue may be accompanied by delayed expansion of an aortic pseudoaneurysm, even if the bolts do not cause direct aortic wall injury. Conclusion This case suggests that understanding the injury mechanism, confirming the tract of the bolts, and carefully exploring traumatic pseudoaneurysm can lead to a less invasive operation due to early detection., Highlights • Crossbow bolts may cause traumatic pseudoaneurysms due to the impact of penetration. • A damage to the surrounding tissue may lead to delayed expansion of pseudoaneurysm. • Three-dimensional reconstruction of computed tomography images can be useful. • Close follow-up for pseudoaneurysm enlargement can avoid mortality and morbidity.

Traumatic pseudoaneurysm is a rare lesion with a high risk of rupture, and represents one of the most difficult lesions to treat, either surgically or endovascularly. Herein, we describe the case of a 32-year-old man with a traumatic pseudoaneurysm of the internal carotid artery, which was treated by overlapped flow diverters (Tubridge). The patient recovered well, and the follow-up angiography at four months showed complete occlusion of the pseudoaneurysm and patency of the internal carotid artery and the ophthalmic artery.

Pseudoaneurysms of facial artery usually arise from the distal part of the vessel. Only 4 cases were described in the literature involving the proximal part of facial artery. We present a case of a traumatic pseudoaneurysm involving the proximal part of facial artery. A 50-year-old man was referred to our department for a progressively growing submandibular mass. He was injured by a sharp object during a car crash 30 days ago. After 3 weeks, the patient noted the appearance of a subcutaneous mass in the left submandibular area. Physical examination revealed a freely movable, painful, and pulsatile swelling. Ultrasound and computerized tomography scan showed a nodular lesion in the left submandibular area in continuity with the facial artery. The diagnosis of pseudoaneurysm of facial artery was suspected. The patient was treated by surgery. The pseudoaneurysm was resected with ligation of the proximal and distal ends of the facial artery.

Objective The management of traumatic pseudoaneurysm (PA) with concomitant arteriovenous fistula (AVF) arising from the thyrocervical trunk is challenging and rarely reported. Here, the usefulness of a multi-modal endovascular strategy for management of traumatic PA and AVF arising from the thyrocervical trunk is presented. A literature review describing unique clinical features and management strategies of traumatic vascular lesions of the thyrocervical trunk is included. Methods A 58-year-old man presented with two PAs arising from the ascending cervical artery (AsCA) and a robust AVF between the AsCA and the left vertebral venous plexus which arose acutely after a stabbing incident. These lesions were managed with endovascular vessel sacrifice via coiling and controlled Onyx injection. Relevant literature was identified via a targeted search of the PubMed database. Results Post-management angiography demonstrated complete occlusion of the two traumatic PAs and successful disconnection of the concomitant AVF. Our literature review demonstrates a shift in preferred management approach from invasive surgery to endovascular treatment due to the lower risk and cosmetic preferability. Conclusion Timely treatment of enlarging PA is necessary for reducing associated morbidity and mortality. While surgical resection has been the mainstay therapy, endovascular management has gained popularity in recent years. The choice of endovascular technique is variable and should be individualized based on patient's clinical status, associated risk factors, and lesion morphology. We have shown that parent vessel sacrifice is safe and effective. Reconstruction with a combination of stents, coils, glue, or liquid embolics may be necessary when collateral flow is limited.

Traumatism of head arteries is rare, but among them, the superficial temporal artery is the most exposed and less protected vessel. A pseudoaneurysm of the superficial temporal artery may occur after blunt head trauma in old patients or during vigorous activity in younger people. Diagnosis should be made primarily upon history and physical examination, while duplex ultrasound is appropriate to confirm the diagnosis and CT scan to exclude other possible concomitant pathologies. Direct surgical treatment is the first and main option to solve bleeding and prevent future complications. Here reported the case of an old woman treated for a post-traumatic STA pseudoaneurysm.

A 60-year-old woman involved in a motor vehicle collision presented with a traumatic pseudoaneurysm of the innominate artery origin in addition to multiple concomitant injuries. She was classified as a high-risk candidate for open repair. An experimental thoracic branched graft device was used for coverage of the injury with the addition of a right carotid-to-left carotid-to-left subclavian artery bypass. Follow-up imaging showed resolution of the pseudoaneurysm and patency of her bypass grafts. This is the first described use of the Mona LSA Branch Thoracic Stent Graft System (Medtronic, Minneapolis, Minn) in the innominate artery.

A rare case of a true temporal artery aneurysm is presented with review of the literature.

Intracranial pseudoaneurysm is a rare entity, with few cases described in the literature, and is mostly associated with a history of traumatic brain injury. Traumatic aneurysms comprise1% of all intracranial aneurysms. In particular, middle meningeal artery (MMA) aneurysms are uncommon and usually caused by a skull fracture in the temporal region. About 40 traumatic MMA aneurysms are reported in the literature, and only 28 nontraumatic aneurysms are reported, usually related to high-flow conditions. The behavior of these aneurysms is largely unknown: both spontaneous resolution and aneurysm growth, leading to subsequent rupture, have been reported. Surgical and endovascular management are feasible for MMA aneurysms; however, the criterion standard treatment is not defined.We report the case of a traumatic pseudoaneurysm of the right MMA treated with an endovascular approach and provide a review of the literature.Aneurysms of the MMA are a rare entity that must be taken into account in the setting of a traumatic brain injury or predisposing factors. The diagnosis and aggressive treatment are mandatory, preventing the devastating consequences of their rupture. Endovascular and surgical techniques are well defined and available, even though there is not a demonstrated superiority in any of them.

Pseudoaneurysm of the superficial temporal artery is rare. It is typically caused by blunt force to the temporal region, and presents as a painless, preauricular, pulsatile mass during the following weeks. We think that its infrequent incidence and unusual presentation warrants an increase in awareness to aid accurate and timely diagnosis. We present a case that developed a few weeks after a head injury, and its subsequent management.

We report a case of traumatic intracranial carotid artery pseudoaneurysm treated with an equine pericardium-covered stent. The patient was admitted to the Emergency Department after sustaining severe polytrauma in a motor vehicle accident. A cavernous carotid pseudoaneurysm was detected after an episode of massive epistaxis that required emergent nasal packing. Treatment with parent vessel sacrifice was ruled out after an unfavourable balloon test occlusion. We opted for an equine pericardium-covered stent as a means to immediately seal the wall defect in the setting of massive bleeding secondary to an unstable lesion. We describe the potential benefits and drawbacks of these prostheses and the technical difficulties encountered in this particular case. To our best knowledge, this is the first published case report on a post-traumatic intracranial internal carotid artery pseudoaneurysm successfully treated with an equine pericardium-covered stent.

Pseudoaneurysms adjacent to exostoses have been commonly reported in the femoral and popliteal arteries and only rarely in the upper extremity. We describe a case of an 18-year-old man with multiple hereditary exostoses who developed a brachial artery pseudoaneurysm after minor trauma to his right upper arm, adjacent to a known lesion. He was referred to a vascular surgeon who removed the pseudoaneurysm and repaired the artery with a saphenous vein graft. We encourage a high suspicion of vascular injury even after minor trauma when an osteochondroma is adjacent to a vascular structure.

Background: Traumatic pseudoaneurysms of the middle meningeal artery (MMA) are rare, associated with skull fractures, and have a high mortality rate. When they rupture, MMA pseudoaneurysms frequently cause epidural hematomas and occasionally ipsilateral subdural or subarachnoid hemorrhage. Isolated intraparenchymal hemorrhage has also been reported. Case Description: A 54-year-old female who suffered a loss of consciousness resulting in a fall presented with a Glasgow Coma Scale of 7t. Imaging demonstrated a right subdural hematoma (SDH) with midline shift, left skull fracture overlying the left MMA, and left temporal lobe intraparenchymal hematoma extending to the surface. The patient underwent a right craniectomy with evacuation of the SDH, and the preoperative computed tomographic angiography revealed abnormal dilation of the left MMA consistent with a pseudoaneurysm. The pseudoaneurysm was treated with endovascular treatment, and the intraparenchymal hematoma was treated conservatively. Her recovery was uneventful, and she received a cranioplasty 3 months after the decompression. Conclusions: The presence of a fracture over the MMA and intraparenchymal hematoma should prompt suspicion for a traumatic pseudoaneurysm. Pseudoaneurysms of the MMA can cause catastrophic bleeding, and prompt treatment is necessary. Endovascular embolization is an effective method that decreases the hemorrhage risk of MMA pseudoaneurysms.

Peripheral arterial aneurysms may be true aneurysms, a dilation of the lumen lined by the remnants of the stretched arterial wall, or a false aneurysm (pseudoaneurysm), a penetration of the luminal wall with contained flow external to the vessel. Pseudoaneurysms are typically a result of blunt or penetrating arterial trauma, which includes a variety of iatrogenic injuries. This case report describes a traumatic psuedoaneurysm of the left internal carotid artery that occurred after a fall resulting in hyperextension of the neck. The psuedoaneurysm was undetected for three months until a sonographic examination for persistent neck pain showed the lesion. Endovascular repair of the pseudoaneurysm was done without complications.

Traumatic pseudoaneurysm of subscapular artery is a rare sequlae of injury in the shoulder region. Only five cases are on report and none after World War II. This rarity of the lesion is due to the anatomic location of the artery 4 . We report a 21 years old patient transferred for torrential bleeding from the wound of entry, followed by appearance of progressively expanding, pulsatile, painful swelling, after three days of splinter injury sustained in right scapular region while working in the field. The diagnosis was confirmed by Doppler ultrasonography and computerized tomographic angiography. Successful surgical aneurysmectomy and ligation of rented subscapular artery done without affecting axillary artery.

BACKGROUND Pseudoaneurysm is very rare in Head Neck region. Psedoaneurysm or false aneurysm develops only from adventitia, lacking one or more of the layers of the vascular wall. Correct clinical diagnosis and management is challenging. CASE REPORT 19 years old male patient presented with a swelling in the left parotid region following trauma in the same region with the sharp end of a scissor. USG and Colour Doppler were suggestive of a A-V malformation. MRI and MR Angiogram showed it to be a pseudoaneurysm arising from superficial temporal artery. Superficial parotidectomy was done followed by ligation of superficial temporal artery. Aneurysm was subsequently excised. DISCUSSION Pseudoaneurysms are relatively rare in the external carotid system. It is most commonly seen in association with superficial temporal artery in external carotid system. Several anatomical factors predispose to such propensity. Imaging studies followed by surgical excision remains the treatment of choice. CONCLUSION Penetrative trauma in the head–neck region is not uncommon. Their exterior entrance may appear benign but deeper part may have significant and dangerous injuries. Any pulsatile mass that follows trauma in the head and neck regions might be a case of pseudoaneurysm.

Middle meningeal artery (MMA) pseudoaneurysms are very rare and are most often traumatic. They may present as an epidural or intraparenchymal hematoma. This study reports a rare case in which a patient suffered from intractable epistaxis because of a pseudoaneurysm in middle meningeal artery and skull base fracture after craniocerebra trauma. Pseudoaneurysm and the feeding artery were embolized by using Onyx-18 liquid embolic system. Complete cessation of bleeding was achieved in this case immediately after the endovascular therapies. In this study, clinical manifestation, diagnostic imaging and endovascular treatment are described. Formation mechanisms and the treatment of traumatic pseudoaneurysm of middle meningeal artery are discussed.

Introduction: Transcranial stab injuries among the civilian population in South Africa are more common than in the West. In a study conducted in Durban, South Africa, in 1992, transcranial stab injuries accounted for 6% of all head injuries admitted to the neurosurgical unit. Digital subtraction angiography (DSA) has been the gold standard for diagnosing traumatic pseudoaneurysms. Its use as a screening tool is, however, limited and carries risks of neurological deficits. We postulate that the newer generation computed tomography (CT) scanner would serve as a better screening tool for traumatic pseudoaneurysms following transcranial stab injuries with the blade removed, provided the image quality is good.Methods: All patients admitted with a stab to the head with total calvarial penetration from September 2014 to January 2016 were included in the study. Those with a retained metallic fragment, incomplete imaging protocols, no penetration of the blade into the brain parenchyma or other causes of penetrating head injury were not included in the study. A retrospective chart review was then done on a prospectively recruited patient cohort. All CT angiograms were performed using a dual source CT scanner.Results: A total of 26 patients met the inclusion criteria. There were seven vascular injuries identified on DSA: three traumatic pseudoaneurysms and four vessel cut-offs. One traumatic pseudoaneurysm was missed on computed tomography angiography (CTA) because of a poor quality scan. The average sensitivity and specificity of CTA compared with DSA was 67% and 95.5%, respectively. Negative predictive value for CTA was 99.5%.Conclusion: A good quality CTA carried out on the newer generation CT scanners allows for use of CTA as a screening tool for patients with a transcranial stab injury and no retained blade or metallic foreign bodies.

A teenager with epistaxis after head trauma was diagnosed with pseudoaneurysm of the internal carotid artery. Three years after the first aneurysm embolization, delayed coil migration was detected. Then the migrated coil was removed through nasal endoscopy.

Introduction: Coil migration (CM) is an extraordinary delayed complication associated with coil embolization as the definitive treatment for pseudoaneurysm (PA). Our case is a recurrent one with episodes occurring in approximately 2-year intervals. Case presentation: A teenager presented with a PA after a car accident in 2014. He was admitted and treated with stent-assisted coils at our institution. The patient experienced delayed coil migration into the nostril in 2017 which we resolved by cutting off the migrated coils under nasal-endoscopy. The remaining coils migrated into the oral cavity in 2019 and were completely pulled out under nasal-endoscopy. Conclusion: When a patient experienced CM in vitro, it is advocated that, the extruding coils be cut off while the remaining coils are left in-situ. As much as possible, coil should not be forcefully pulled out. Keywords: Recurrent, Pseudoaneurysm, Coil migration, Endovascular

Pseudo aneurysms of the superficial temporal artery (STA) are very rare (less than 1% of aneurysms), and usually occur after blunt head injury. It usually presents as a slow growing, pulsatile mass in the temporal area. Other symptoms that may occur are headache, ear pain, facial palsy or haemorrhage. Arteriography is the diagnostic investigation and computed tomography angiography will exclude other conditions such as arteriovenous malformation and fistula and confirm the diagnosis. Surgery with ligation of the proximal and the distal parts of the vessel and resection of the aneurysm is the treatment of choice. We report the case of a 10-year-old child, with a pseudo aneurysm of the STA secondary to trauma, who underwent surgical resection of the lesion with good outcome.

INTRODUCTION: Aneurysms of the external carotid circulation are rare. Of these aneurysms, scalp aneurysms involving the occipital artery are the rarest.1Aneurysms can be divided into two categories—false and true. The designation false, or pseudo-, indicates that the vascular wall has been breached and the aneurysmal sac is lined with the outer arterial layers or periarterial tissue. True aneurysms are different in that the dilated portion of the vessel is lined with all three layers of the native blood vessel—the intima, the media, and the adventitia.2 Most traumatic aneurysms are false aneurysms. In a review of the world literature from 1644 published in 1998, Conner et al found only 386 reported cases of traumatic aneurysms and pseudoaneurysms of the face and temple, most of which were superficial temporal artery aneurysms.3 Only two of these cases involved traumatic pseudoaneurysms of the occipital artery.4 Previously eleven cases of traumatic occipital artery aneurysm has been reported.1, 5 Although the true incidence of traumatic pseudoaneurysms of the occipital artery is unknown, it is obvious that they are rare. In this article, we report twelfth case of the world.

Background Superficial temporal artery (STA) aneurysms are an uncommon entity and mostly described in case studies. The purpose of this review was to show the studied clinical presentation, diagnostic modalities, and treatment modalities of STA aneurysms. Methods A review was performed of reports on STA aneurysms published until December 2010, using the MEDLINE and Cochrane databases. Results One hundred sixty-six pseudoaneurysms and 20 true aneurysms were described. The majority of patients presented with a painless pulsatile mass. Historically, angiography was most often used, but ultrasound scan, CT, and MRI may be superior. Surgical resection was performed in 128 pseudoaneurysms and 20 true aneurysms with 1 recurrence and few complications. Endovascular approaches were used in 13% of pseudoaneurysms with an 80% success rate. Conclusion Pseudoaneurysms are mostly the result of blunt trauma as opposed to true aneurysms which usually occur spontaneously. Surgical resection is a safe treatment modality, but endovascular treatment might be considered in a selected group of patients. (c) 2012 Wiley Periodicals, Inc. Head Neck, 2013

Le pseudo-anévrisme provient d'une solution de la continuité de la paroi artérielle, secondaire à l'inflammation, un traumatisme ou des causes iatrogènes telles que la chirurgie, une biopsie percutanée ou un drainage. Nous rapportons un cas d'un patient de 37 ans, venant consulter pour constatation d'une tuméfaction cervicale évoluant progressivement suite à un traumatisme cervical pénétrant survenu 8 mois auparavant. L'échographie doppler complétée par un angioscanner a confirmé le diagnostic de pseudo-anévrisme de l'artère carotide externe gauche. Le diagnostic de pseudo-anévrisme est plus aisé avec le développement considérable de l'imagerie en coupe et de l'angiographie.

Background Pseudoaneurysms as result of orthopaedic injuries are a known clinical entity. But with increase in operative interventions and use of implants, its incidence is bound to increase. It is important to detect this complication at the earliest to avoid any limb or life threatening problems. Selective angiography is a minimally invasive technique to pin point the diagnosis and at the same time allow for therapeutic embolization/stenting of the pseudo aneurysm. Methods A retrospective review of inpatients from January 2007 to January 2013 requiring transarterial embolization/stenting for pseudoaneurysm in the limbs. All patients had evidence of pseudoaneurysm as proved by radiological findings. Angiographic intervention in a cath lab was performed, following which patients were monitored for morbidity and mortality benefits on short and long term follow up. Results Out of the total 13 patients; 7 adults and 1 child underwent embolisation with polyvinyl alcohol particle/soft metal coil, whereas the remaining 5 adults underwent revascularisation with covered stent. The mean age of patients in our case series was 41.92 ± 18.89 years. The mean follow up period of the group was 14.61 ± 12.21 months. All but one patients showed significant clinical improvement with endovascular management with no procedure related mortality. Conclusion Endovascular management is the modality of choice in comparison to other procedures for traumatic pseudoaneurysms in both paediatric and adult patients.

Traumatic pseudoaneurysm of the superficial temporal artery is a very rare lesion and usually presents as a painless pulsatile mass in the temporal region a few weeks after trauma. The infrequent incidence and sometimes perplexing presentation still warrants the need for awareness of its presentation and diagnosis. We report a case of traumatic pseudoaneurysm of the superficial temporal artery that presented a few weeks after blunt trauma to the head in an 18 year old. We also review the optimal approach to the diagnosis and management of the lesion.

A 42-year-old man was involved in a motor vehicle collision. Imaging studies revealed the presence of a post-traumatic aortic pseudo-aneurysm (about 34 × 26 cm) arising from the descending thoracic aorta at the level of the left subclavian artery (LSA), prone to rupture. Thoracic endovascular aneurysm repair (TEVAR) was the only feasible option due to his poor overall medical status. In this case, LSA needed to be covered in order to extend the proximal landing zone. Eventually, modified TEVAR was successfully performed by means of the chimney technique to preserve flow to the LSA and to prevent flow into the pseudoaneurysmal sac.

Pseudoaneurysms of the posterior tibial artery are rare, but a high index of suspicion should be maintained in evaluating patients who present with a painful swelling after arterial trauma. We report a case of a posterior tibial artery pseudoaneurysm in a young patient sustained from a laceration and associated profuse arterial bleeding. Because of the risk of rupture and the presence of an infection and high venous flow, an embolization of the aneurysm proximally and distally was carried out after verifying that distal collateral circulation ensured foot vascularization. Endovascular treatment of a pseudoaneurysm seems to be a safe therapeutic and noninvasive choice, particularly in young patients in whom the presence of collaterals guarantees distal vascularization and in whom the procedure can be safely performed in the presence of a superficial wound infection.Levels of Evidence: Therapeutic Level IV, Case Study

Traumatic pseudoaneurysms of the internal maxillary artery (IMA) are rare and difficult to treat. A 58-year-old man with a traumatic pseudoaneurysm of the IMA presented with intractable nasal and oral hemorrhage during dual antiplatelet therapy. Transcatheter artery embolization with N-butyl cyanoacrylate (NBCA) completely occluded the pseudoaneurysm. Transcatheter artery embolization with NBCA is a feasible and effective treatment because of its shorter treatment time and lower incidence of recurrence.

Traumatic pseudoaneurysm of internal carotid artery is a rare complication of injury after craniomaxillofacial trauma. Delayed recurrent epistaxis after head and facial trauma is the most distinctive manifestation of traumatic internal carotid artery pseudoaneurysm. Epistaxis due to pseudoaneurysm of internal carotid artery is difficult to control, and may lead to hemorrhagic shock or asphyxia and thus seriously threatens life. The purpose of this paper is to present a rare case of recurrent epistaxis secondary to ICA pseudoaneurysm following blunt maxillofacial trauma. Endovascular stenting was performed and the recurrent epistaxis was successfully arrested. How to cite this article Kumar D, Sahu GR, Kumar A, Mukherjee KK, Rattan V. Traumatic Pseudoaneurysm of Internal Carotid Artery presenting as Intractable Epistaxis in a Case of Maxillary Fracture. J Postgrad Med Edu Res 2014;48(2):100-102.