PMC2684995_01
Enhanced CT scan (A) and left occipital arteriogram (B) reveal a pseudoaneurysm in the scalp.
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F1
Brain CT revealed a slight increase in the attenuation of the hematoma in the left parietal scalp, with dense contrast filling (Fig. 1A). Angiography of the external carotid artery revealed a pseudoaneurysm, which was fed by the left occipital artery (Fig. 1B).
Doppler ultrasonogram five days after manual compression reveals a crescent-shaped residual blood flow.
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F2
We detected a residual blood flow to the inferior portion of the sac (Fig. 2).
Direct puncture embolization of pseudoaneurysm.. Test injection of contrast media after puncture (A) reveals reflux flow to the proximal occipital artery, in spite of cautious injection. Manual compression of the proximal occipital artery greatly reduces the extent of the reflux (B). After injection of a mixture of N-butyl-2-cyanoacrylate and Lipiodol during the manual compression of the proximal occipital artery, the cast-filling pseudoaneurysm is easily visualized on the fluoroscope (C).
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F3
At this time, an attempt was made to occlude the pseudoaneurysm via direct puncture embolization (Fig. 3).
Color Doppler ultrasonogram eight days after embolization reveals the complete disappearance of flow into the pseudoaneurysm.
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F4
Complete occlusion was confirmed by Doppler US, which was taken eight days later (Fig. 4).