A young boy with a lacerated wound presented with a painful growing mass arising from the lesion.
A 10-year-old boy was brought to the emergency department with complaints of a growing lesion on the palm of his left hand. The mass was painful and pulsatile.
Three days before presenting to the ED, the boy’s hand had been lacerated with a kitchen knife that had been sutured in the emergency department after the initial injury.
The growing mass was suspected to be a wound abscess, so povidone-iodine was applied to the hand before performing incision and drainage.
On examination of the hand before the procedure, a large pulsatile mass (Panel A) was noticed arising from the previous wound. The mass was neither warm nor erythematous. No neurovascular impairment was identified on examination.
On auscultation of the lesion, a bruit was heard.
The mass (aneurysm) was isolated and excised. Postoperatively, the patient recovered without any complications.
Such vascular anomalies or arterial aneurysms of the hand are rare and can either be due to trauma or non-traumatic causes, including congenital, postinfectious, inflammatory, or atherosclerosis. There is a substantial risk of bleeding from the mass even during the excision.
Usually, the acquired cases present with a pulsatile painful growing mass which may lead to sensory impairment of the hand nerves secondary to compression.
Complications include digital ischemia, neurovascular compromise, and chronic pain.
These aneurysms can be treated non-operatively if small and asymptomatic, but larger, symptomatic lesions may require surgical exploration, ligation, or excision.
References
Paige E. Stevens, M. a. (2020, August 20). Traumatic Vascular Injury to the Hand. Retrieved from The New England Journal of Medicine: https://www.nejm.org/doi/full/10.1056/NEJMicm2000950
Watts, E. (2016, May 10). Digital Artery Aneurysm. Retrieved from OrthoBullets: https://www.orthobullets.com/hand/12282/digital-artery-aneurysm
Shutze RA, Leichty J, Shutze WP. Palmar artery aneurysm. Proc (Bayl Univ Med Cent). 2017;30(1):50-51. DOI:10.1080/08998280.2017.11929524
