PMC5996638_01
Patient at time of presentation with globular swelling (arrow) anterosuperior to the left tragus
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F1
On local physical examination, a well-defined roughly spherical-shaped globular, nontender, pulsatile mass of about 30 mm x 30 mm was seen over left preauricular region anterosuperior to the left tragus [Figure 1], it was easily compressible on digital pressure.
(a) Computed tomography angiography showing pseudoaneurysm of left superficial temporal artery. (b) Ultrasonography Doppler of left preauricular region demonstrating thrombus and flow (blue color) within the aneurysm. (c) Ultrasonography Doppler of left preauricular region demonstrating another small thrombosed pseudoaneurysm
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F2
CT angiography revealed well defined, round to oval, hyperdense lesion measuring approximately 2.7 cm x 2 cm in left temporal space in the suprazygomatic region with nonenhancing hypodense area within the lesion suggesting partially thrombosed pseudoaneurysm from the superficial temporal branch [Figure 2a]. Another small pseudoaneurysm was seen adjacent to above-described pseudoaneurysm and appeared thrombosed [Figure 2b and c].
(a) Intraoperative photograph showing pseudoaneurysm raised with temporal flap. (b) Ligation of proximal and distal end of superficial temporal artery. (c) Resected specimen
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F3
Under general anesthesia, surgical exploration by Alkayat-Brahmley incision and temporal flap elevation was done [Figure 3a]. The mass was excised and proximal and distal cut ends of the artery were ligated [Figure 3b]. A 3.0 cm x 3.0 cm mass was resected [Figure 3c].
H and E, section of the surgically resected pseudoaneurysm (a) Magnification x100; (b) Magnification x400
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F4
The report stated hematoma in arterial wall beneath thinned out adventitia and fibrovascular stroma with extravasated red blood cells [Figure 4a and b].
One-year postoperative photograph
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F5
The patient recovered uneventfully after surgery and there is no recurrence after 1 year of surgery [Figure 5].