Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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October 25, 2010 (Main)
Post-traumatic Superficial Temporal Artery Pseudoaneurysm
- Superficial temporal artery pseudoaneurysms (STAP) are uncommon and usually are the result of trauma to the frontotemporal region.
- Causes include sports-related trauma, non-sports related trauma, i.e. gun-shot wounds, assault, etc., and iatrogenic causes such as after cyst removal, punch hair grafting, and craniotomies.
- Common presenting symptoms are a solitary painless mass in the preauricular region accompanied by pulsations, headache, or ear discomfort. A physical examination typically identifies a firm, nontender, pulsatile mass.
- Key Diagnostic Features: Color doppler ultrasound, CT angiogram, MR angiogram and DSA can be used to establish the diagnosis. Cross-sectional imaging demonstrates an intensely enhancing lobulated lesion arising from the superficial temporal artery. Maximum intensity projections (MIP) and 3-D surface-shaded-displays (SSD) aid demonstrate the aneurysm better.
- DDx: include STA AVF, and aneurysm of the middle meningeal artery with erosion of the temporal bone. Other differential diagnoses include hematoma, abscess, inflammatory lesion, epidermal inclusion cyst, angiofibroma, meningocele, encephalocele, pseudomeningocele, parotid mass, and lipoma.
- Surgical indications are pain, cosmetic deformity, and the potential for rupture.
- Treatment: Definitive treatment includes ligation of afferent and efferent vessels and surgical excision of pseudoaneurysm.
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