Man with a Forehead Mass: Detection of a Forehead Pseudoaneurysm with Bedside Ultrasonography

Abstract

A vascular pseudoaneurysm can present similarly to an abscess; yet incision and drainage of a pseudoaneurysm can lead to uncontrolled bleeding and expose the patient to further morbidity. This is a case of a patient with a forehead pseudoaneurysm who presented to our emergency room after blunt head trauma. Here we review different diagnostic modalities as well as some of the treatment options that are described in the literature.

Unusual diagnosis in a patient with minor ankle trauma

“…19 Bedside diagnosis of post-traumatic arterial pseudoaneurysms of the face and lower limb, using point-of-care ultrasonography performed by the ED physician, has indeed been described in a few case reports of single patients. 18,[20][21][22] The bedside technique most commonly described consists of linear ultrasound probe placement directly over the area of maximal swelling (or bruit/ thrill, if present). 18,20 The anechoic pseudoaneurysm cavity may be pulsatile and is commonly surrounded by hypoechoic thrombus (Figure 2).…”

“…18,22 This sonographic appearance may closely resemble that of an abscess cavity with debris. 21 The use of color Doppler is particularly valuable in differentiating the two. Characteristic findings of pseudoaneurysm include bidirectional blood flow in the pseudoaneurysm neck, pulsatile flow in the cavity (Figure 3), and the "yin-yang sign" (swirling blood in the pseudoaneurysm resembling the ancient symbol).…”

Hemorrhage due to attempted excision of a frontal exophytic lesion: A cautionary tale

“…[ 4 ] In this context, the doppler ultrasonography might be a cost-effectively and widely available alternative in establishing differential diagnosis between a large subcutaneous lesion and an intracranial exophytic lesion demanding specialized neurosurgical care [ Figure 2 ]. [ 1 ]…”