Child With Painful Palmar Mass

doi:10.1016/j.annemergmed.2013.05.007

Annals of Emergency Medicine

Volume 62, Issue 6, December 2013, Pages 569, 577

https://doi.org/10.1016/j.annemergmed.2013.05.007 Get rights and content

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Superficial palmar arch pseudoaneurysm

A pseudoaneurysm of the superficial palmar arch is a rare occurrence most commonly reported after penetrating trauma to the artery.1, 2, 3, 4 Disruption of the arterial wall results in bleeding and formation of an adjacent hematoma, which is later surrounded by fibrous tissue, creating a continuous pocket with the artery. In contrast, a true aneurysm is a dilation involving all 3 arterial layers.⁴

Clinical presentation can include pain, swelling, and a pulsatile mass in the palm near the site of

References (5)

C.D. Hughes et al.
Pseudoaneurysm in the hand of a three-year-old boy: a case report
J Emerg Med
(2012)
E.P. Estrella et al.
Aneurysm of the superficial palmar arch: a case report
Hand Surg
(2008)

There are more references available in the full text version of this article.

Cited by (6)

Successful conservative management of a superficial pediatric pseudoaneurysm
2018, Journal of Pediatric Surgery Case Reports
Citation Excerpt :
She did not require medical therapy (such as factor replacement). Twelve case reports of 13 superficial pseudoaneurysms met the inclusion criteria [4,6–16] (Fig. 3, Tables 1 and 2). We included our case in the calculation of descriptive statistics for a total of 14 cases (n = 14, 7 males, 5 females, and two patients with unspecified gender).
(1) To report a case of successful non-operative management of a pediatric pseudoaneurysm in a patient with severe factor V deficiency. (2) To review the literature on pediatric pseudoaneurysms managed with a trial of conservative therapy.
A review of the literature was conducted on OVID-Medline for case reports or series of pediatric pseudoaneurysms managed conservatively (observation or external compression). Only superficial, radiologically confirmed pseudoaneurysms managed conservatively were included. Demographic data, etiology, treatment modalities, success rates, and definitive management for cases where conservative management failed were examined.
Twelve case reports of 13 pseudoaneurysms met inclusion criteria. Including our case, the mean age was 7 years and the most common pseudoaneurysm etiology was iatrogenic (57%). Seventy-nine per cent (11/14) of pseudoaneurysms resolved with conservative management, and 21% (3/14) proceeded to surgery due to increasing size, bleeding, or pain. Of those pseudoaneurysms successfully treated conservatively, 18% (2/11) developed a complication. Five pseudoaneurysms occurred in patients with coagulopathies, all of which resolved conservatively.
In stable, asymptomatic superficial pediatric pseudoaneurysms, a trial of conservative management and close follow-up is a reasonable option, even in patients with coagulopathies.
A Pseudoaneurysm of the Deep Palmar Arch after Penetrating Trauma to the Hand: Successful Exclusion by Ultrasound Guided Percutaneous Thrombin Injection
2016, EJVES Short Reports
Citation Excerpt :
Current medical literature describes surgery as the preferred treatment option. Arteries were repaired or resected, with or without performing bypass surgery.2–5 Ultrasound guided thrombin injection is found to be an effective, time saving, and safe procedure in the treatment of pseudoaneurysms of the femoral artery.1
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.
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.
Thrombin injection might be a safe alternative option in the treatment of pseudoaneurysm of the deep palmar arch.
In reply
2014, Annals of Emergency Medicine
Upper extremity pseudoaneurysms thrombose more likely than currently believed
2014, Annals of Emergency Medicine
Pseudoaneurysm: An unusual cause of post-traumatic hand swelling
2015, BMJ Case Reports
Point-of-care ultrasound to identify distal ulnar artery thrombosis: Case of hypothenar hammer syndrome
2015, Western Journal of Emergency Medicine

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Section snippets

Superficial palmar arch pseudoaneurysm

J Emerg Med

Aneurysm of the superficial palmar arch: a case report

Hand Surg

Images in emergency medicine
Child With Painful Palmar Mass