PMC6586101_01
On initial presentation, the patient had a 1 cm slightly bluish, pulsatile, non-tender soft tissue mass over the course of the left radial artery, concerning for a vascular anomaly.
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On examination, the patient had a 1 cm bluish, non-tender, pulsatile mass over the left radial artery (Figure 1).
Magnetic resonance angiography (coronal, sagittal, and axial views) revealed a 1.1 x 0.8 x 1.0 cm mass with retrograde arterial filling arising laterally off the distal radial artery from the superficial palmar arch with evidence of thrombosis of the artery proximal to the lesion and intact superficial and deep palmar arches.
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Magnetic resonance angiography (MRA) demonstrated a 1.1 x 0.8 x 1.0 cm mass arising off the radial artery with retrograde filling from the superficial palmar arch and thrombosis proximal to the lesion (Figure 2).
A. Intraoperatively, the lesion was pulsatile, grossly multi-lobular, and reddish and focally bluish in colour with fibrous attachments to the flexor carpi radialis sheath. The radial artery was resected proximally to the mid-forearm and distally just past the wrist flexion crease. Photomicrographs exhibiting pseudoaneurysmal radial artery with scant residual media (asterisks) and striking intimal fibroplasia (arrow). Verhoeff-van Giesson stains (3B) original magnification, x40. (3C) original magnification, x500.
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Intraoperatively, the arterial lesion was noted to be multi-lobular, focally bluish, and adhered to the flexor carpi radialis sheath, with the volar carpal branch of the radial artery exiting the mass. (Figure 3(A)). On histopathology, the specimen exhibited medial attenuation with large areas of complete media loss, consistent with pseudoaneurysm (Figure 3(B,C)).