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Clinical Problem Solving: Radiology
April 2008

Radiology Quiz Case 2: Diagnosis

Author Affiliations

Copyright 2008 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2008

Arch Otolaryngol Head Neck Surg. 2008;134(4):445. doi:10.1001/archotol.134.4.445

Pseudoaneurysms are contained collections of turbulent flow that are in direct communication with an artery. Unlike a true aneurysm, a pseudoaneurysm does not involve all 3 layers of the vessel wall. It occurs as a result of a partial injury to an arterial wall, which in turn causes a hematoma that is contained by surrounding soft tissues. Subsequently, the hematoma liquefies, and the pulsatile arterial flow is contained by a fibrous capsule. Pseudoaneurysms can rupture under sustained arterial pressure.They occur days to months after the initial trauma as an expansile, pulsatile swelling. Unlike arteriovenous fistulas, in which a continuous machinery murmur is heard along with a palpable thrill, pseudoaneurysms have an audible bruit that is heard only during systole. A review of the world literature from 1644 to 1998 by Conner et al1revealed that 85% of the 386 reported cases of traumatic aneurysms of the face and temple were found in the superficial temporal artery, 7% were found in the internal maxillary artery, and 7% were found in the facial artery. In another series, only 21 of more than 8000 aneurysms were pseudoaneurysms that occurred in extracranial arteries.2