Diagnosis and excision of an ulnar artery aneurysm in a two-year-old boy

Abstract

U lnar artery aneurysms are exceedingly rare in children younger than 10 years of age, with fewer than 10 cases reported worldwide. Secondary to their rarity, the etiology of these lesions is not yet understood. Ulnar artery aneurysms have been characterized in the adult population, usually occurring secondary to occupationally acquired, repetitive stress disorders such as hypothenar hammer syndrome (1-3). The present case report describes the course of treatment for an ulnar aneurysm in the wrist of a two-year-old boy, along with a brief review of the existing literature detailing other approaches to management. CASE prESEntAtionA two-year-old boy presented with a bump on the left arm, which was noticed by the mother during a trip to the emergency room for suspected trauma to the wrist. The mass was originally believed to be a ganglion cyst. It was not known whether the mass had changed in size between the time of discovery and the time of visit to the office. Apart from the visit to the emergency room, the patient's medical history involved a case of omphalitis at 21 days and a frenectomy for tongue-tie at 1.5 months of age, with no history of arterial line placement. The patient's family history of similar lesions was negative.Ultrasound characterized the mass as an ovoid lesion, with the possibility of being a large pseudoaneurysm of the ulnar artery.On physical examination in the office, the mass on the left wrist appeared to be a ganglion cyst. Neither bruit nor thrill were noted, and neurovascularity was normal. No finger ischemia was noted.Magnetic resonance angiography identified the mass on the volar aspect of the left wrist to be a large pseudoaneurysm of the distal ulnar artery just anterior to the wrist. The dimensions were approximately 1.8 cm in length by 1.0 cm in width by 1.2 cm in height. Heterogeneous signal intensities with hyperdense elements on T1 were suggestive of thrombus. No arteriovenous malformations were noted. Magnetic resonance imaging suggested a true aneurysm with thrombosis. The lesion was not determined to occlude the ulnar artery, and an angiographic arteriogram was to be performed to determine both the characteristics of the lesion and whether repair of the ulnar artery was necessary after excision of the aneurysm. Consultation with a geneticist was also elected to investigate possible clinically important congenital or connective tissue disorders such as Kawasaki, Marfan's or Ehlers-Danlos syndromes because they have been implicated in the development of ulnar artery aneurysms (4,5). Based on meeting with the geneticist, the patient was determined to have no connective tissue disorders.Intraoperative arteriogram, 16 days after the magnetic resonance imaging/magnetic resonance angiography, noted that the ulnar artery was completely occluded (Figure 1). No contrast entered the lesion itself and no emboli were noted. A long gap between the end of contrast and the level of the wrist was case report ©2010 Pulsus Group Inc. All rights reserved i Amjad, t Murphy, E Zahn. Diagnosis ...

A case of congenital aneurysm of the ulnar artery of the palm

“…Among the 15 cases previously reported [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] , the site of occurrence was the ulnar artery in 10 cases, the common digital artery in four cases, and the palmar arch in one case; the ulnar artery was involved in 67% of cases [ Table 1]. Okuda et al .…”

“…[9] 2008 12 years M R Right Ulnar Resection + vein graft Amjad et al . [10] 2010 2 years M L Ulnar Resection…”

Multilocular True Ulnar Artery Aneurysm in a Pediatric Patient

“…Despite the fact that patients may be asymptomatic, intervention in these cases is always warranted because of the risk for embolic events and the potential sequelae. 5 , 10 , 11 Although selective endovascular embolization is theoretically possible, questions about the adequacy of arterial perfusion to the hand following ablation of the aneurysm have resulted in most authors addressing these lesions with an open surgical approach. 3 – 5 , 8 ,12,13…”

“… 2 However, vein grafts from the forearm, dorsum of the foot, or the saphenous system is readily available, have demonstrated excellent outcomes, and are the most common approach in these patients. 2 , 8 , 10 And though long-term studies are not available in the pediatric population because of the low incidence of disease, no significant postoperative complications have been described. We believe this treatment modality should be considered as the primary approach in these cases because of the potential pitfalls of less invasive and less comprehensive measures.…”

Congenital aneurysm of the palmar digital artery: A case report and literature review

“…Nontraumatic causes of aneurysms in adults are associated with atherosclerosis, infection, and other less common causes [3] . Congenital aneurysms or true arterial aneurysms of the hand are exceptionally rare in the pediatric population [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] . Very little is known regarding their causation and treatment algorithms have not been developed in the pediatric population.…”