Percutaneous Ultrasound-Guided Thrombin Injection for Coagulation of a Post-Traumatic Superficial Temporal Artery Pseudoaneurysm

Abstract

Introduction

Pseudoaneurysm of the superficial temporal artery (STA) is rare and most commonly caused by blunt trauma. The STA is the most frequent site of traumatic aneurysm in the face because of its anatomic location. The diagnosis is easily confirmed by color duplex ultrasound. The usual treatment is surgical ligation and resection. This type of pseudoaneurysm can be successfully treated by ultrasound-guided injection of thrombin, which is easy, quick, and cost-effective.

Case report

A 71-year old man on Coumadin therapy fell out of bed and lacerated his right forehead. A pulsatile mass under the laceration was imaged with color duplex ultrasound, which demonstrated a 1.5- x 1.0-cm pseudoaneurysm off a branch of the STA, 6 mm below the skin line. Under ultrasound guidance, a 21-gauge needle was introduced into the pseudoaneurysm and 300 units of thrombin was injected into the sac with complete thrombosis of the pseudoaneurysm cavity. The STA remained patent after the procedure, and the pseudoaneurysm remained thrombosed after the procedure.

Conclusions

Post-traumatic STA pseudoaneurysm can be safely and successfully treated with ultrasound-guided injection of thrombin. Percutaneous ultrasound-guided injection of thrombin for repair of post-traumatic STA pseudoaneurysm is a fast, safe, and effective alternative to surgical repair resulting in rapid thrombosis of the pseudoaneurysm.