- Email: [email protected]
Intramuscular lipoma of the cheek: A case report
J Oral Maxillofac Surg 58:817-819, 2000
Intramuscular Lipoma of the Cheek: A Case Report Adriano Piattelli, MD, DDS,* Massimiliano Fioroni, DDS,† and Corrado Rubini, MD‡ exceedingly rare in the oral cavity, and only 6 cases have been reported.7,8 Four cases were located in the tongue, 1 in the submandibular region, and 1 in the cheek.7 Recently, Bataineh et al9 reviewed 7 previously reported cases of infiltrating lipoma of the oral cavity found in the literature since 1982 and added 3 previously unrecorded cases. Because of its rarity, we report an additional case of intramuscular lipoma of the oral cavity.
Lipoma is a tumor composed exclusively of adipocytes without atypia.1 They account for approximately 1% of all benign tumors of the oral cavity2; however, other investigators believe that lipomas are much more common than has previously been recognized.3 Approximately 220 cases of intraoral lipoma have been reported in the literature.4 Lipoma is different from normal body fat in that its lipids are not available for metabolism, and it has been suggested that this fact, together with its autonomous growth, may warrant its classification as a true benign neoplasm.2 Lipomas usually consist of a demarcated mass in the subcutaneous tissue but also may be less circumscribed, deeply situated lesions involving muscle, nerve, or synovium.1,5 The latter lesions are called intramuscular lipomas or infiltrating lipomas.5 They are comparatively uncommon tumors, and Allen6 reported only 3 cases in approximately 87,000 routine surgical cases. Two varieties of deep-seated intramuscular lipomas have been described: lipomas and angiolipomas.7 The angiolipoma is distinguished from the lipoma by its prominent vascular components8; infiltrating lipomas are composed of mature adipose cells, inconspicuous blood vessels, and delicate strands of connective tissue.9 Infiltrating lipomas are usually located in the limbs.5,8,10-12 Fifty percent are located in the thigh, 20% in the shoulder region and upper arm, 20% in the chest wall, and 10% in other locations.6 They are
Report of Case A 45-year-old man presented with a 4- to 5-cm painless mass in the left cheek (Fig 1) that had been present for 6 months. The lesion was covered by normal-appearing mucosa, seemed to be circumscribed, and it was tethered to the superficial and deeper structures. On palpation, the lesion was firm and nonfluctuant. The lesion was removed under local anesthesia. The removal was difficult, because the lesion was firmly attached to the neighboring soft tissues. The gross appearance was that of an irregular, lobulated, firm, fibrofatty lesion with no evidence of encapsulation (Fig 2). The cut surface was pale yellow. Microscopically, the lesion showed a diffuse infiltration of entrapped striated muscle, with no lipoblasts and a complete absence of cellular atypia (Fig 3). The final microscopic diagnosis was intramuscular lipoma of the cheek. There has been no evidence of recurrence after a 4-year follow-up.
Discussion Tumors of adipose tissue represent the most common form of soft tissue neoplasm in adults, and most lipomatous lesions do not present any particular diagnostic problems.13 Conversely, there exist a group of benign lipomatous tumors, including spindle cell and pleomorphic lipomas, lipoblastoma, and intramuscular lipoma, that may cause considerable diagnostic difficulty and are occasionally mistaken for liposarcomas.13 Oral lipomas usually originate in the submucous fat and can occur in any soft tissue area,3,14 but the cheek and tongue account for about half of published cases. Oral infiltrating lipomas seem to be larger than the ordinary oral lipomas, and they are deep-seated, slowgrowing, generally painless masses that can cause swelling and deformity.5-7 Macroscopically they are well-circumscribed, rounded, and often lobulated tu-
*Professor of Oral Medicine and Pathology, Dental School, University of Chieti, Italy; Honorary Senior Lecturer, Eastman Dental Institute for Oral Health Care Sciences, London, United Kingdom. †Research Fellow, Dental School, University of Ancona, Italy. ‡Researcher, Institute of Pathologic Anatomy and Histopathology, University of Ancona, Italy. Supported by the National Research Council (C.N.R.), Rome, Italy; and by the Ministry of University, Research, Science and Technology (M.U.R.S.T.), Rome, Italy. Address correspondence and reprint requests to Dr Piattelli: Via F Sciucchi 63, 66100 Chieti, Italy; e-mail: [email protected]
r 2000 American Association of Oral and Maxillofacial Surgeons 0278-2391/00/5807-0020$3.00/0 doi:10.1053/joms.2000.7281
817
818
INTRAMUSCULAR LIPOMA OF THE CHEEK
FIGURE 3. Photomicrograph showing diffuse infiltration of the striated muscle tissue. No lipoblasts are present, and there is complete absence of cellular atypia (hematoxylin and eosin, original magnification ⫻200).
FIGURE 1. Lesion of the cheek at the time of first presentation of the patient.
mors.6 The size can vary from small lesions to tumors with a 20-cm or greater diameter.5,6 These tumors present clinical features that often help to distinguish them from other soft tissue tumors, namely, their slow growth, flat appearance, and a soft texture when the surrounding muscle is relaxed11; they appear spherical when the affected muscle contracts.5,6 Usually these tumors are not encapsulated.7,11 On rare occasions, the infiltration is so extensive that it can cause muscle dysfunction or sensory changes because of pressure on nerve trunks7; pain is rarely severe.7 A high rate of recurrences, perhaps attributable to the difficulty in excision, is always associated with these tumors.7,15 In the reported head and neck cases, the recurrence rate has been from 27.3% to 62.5%.10 Microscopically, there is a consistent and diffuse
infiltration with dissociation and entrapment of the muscle fibers, some of which show degenerative changes.7,9,11,16 The muscle tissue is replaced by the fat, which may extend beyond the muscle fascia into the intermuscular connective tissue spaces.5,17 Fascia, joint capsules, bones, and nerves also may be infiltrated.7 Because of the infiltrative nature and potentially high rate of recurrence after inadequate surgery, complete surgical excision is mandatory.10 Recurrence is always attributable to technical error.17 In addition to inadequate excision, a continued proliferation could contribute to the high recurrence rate.9,11,18 All recurrences have shown a histologic appearance similar to that of the original tumor.10 In intramuscular lipoma, the lipocytes are mature, and there are no lipoblasts or cells with atypical nuclei as in a well-differentiated liposarcoma.5,15 Lipoblasts have an eccentric, hyperchromatic nucleus that is indented or scalloped by the presence of 1 or more fat vacuoles.19 Moreover, liposarcomas show myxoid degeneration, pleomorphism, and mitoses.11 Some authors prefer to include the atypical lipomatous lesions among the liposarcomas because of their high recurrence rate, but also because some of them may recur as less differentiated and fully malignant neoplasms.20 However, it must be stressed that it is possible to observe large areas of well-differentiated liposarcoma that are indistinguishable from an intramuscular lipoma.5 The high rate of recurrence casts doubt on the benign histologic pattern.11
References
FIGURE 2. The lesion being removed. It appears as a circumscribed, nonencapsulated, yellow, fatty tumor.
1. Weiss SW: Histological Typing of Soft Tissue Tumors (ed 2). Berlin, Germany, Springer Verlag, 1994, p 23 2. Ghandour K, Issa M: Lipoma of the floor of the mouth. Oral Surg Oral Med Oral Pathol 73:59, 1992 3. Wilson GW, Braun TW, Smith RL: Nodular mass in the anterior floor of the mouth. J Oral Maxillofac Surg 48:492, 1990
´ NCHEZ, DELGADO, AND RAMOS SA 4. Maia Campos G, Grandini SA, Lopes RA: Angiolipoma of the cheek. Int J Oral Surg 9:486, 1980 5. Enzinger FM, Weiss SW: Soft Tissue Tumors (ed 3). St Louis, MO, Mosby, 1995, p 410-412 6. Allen PW: Tumors and Proliferations of Adipose Tissue: A Clinicopathologic Approach. New York, NY, Masson, 1981, pp 7-8 7. Pe´lissier A, Sawaf MH, Shabana AHM: Infiltrating (intramuscular) benign lipoma of the head and neck. J Oral Maxillofac Surg 49:1231, 1991 8. Wilson GW, Braun TW, Smith RL: Nodular mass in the anterior floor of the mouth. J Oral Maxillofac Surg 48:492, 1990 9. Bataineh AB, Mansour MJ, Abalkhail A: Oral infiltrating lipomas. Br J Oral Maxillofac Surg 34:520, 1996 10. Garavaglia J, Gnepp DR: Intramuscular (infiltrating) lipoma of the tongue. Oral Surg Oral Med Oral Pathol 63:348, 1987 11. Akasaka N, Chino T Jr, Chino T, et al: Infiltrating lipoma of the mental region: Report of case. Br J Oral Maxillofac Surg 31:388, 1993
819 12. Sanchez Aniceto G, Salvan Saez R, Garcia Penin A: Angiolipoma of the cheek: Report of a case. J Oral Maxillofac Surg 48:512, 1990 13. Chung ED, Cavazzana AO, Fassina AS: Tumors of adipose tissue, in Ninfo V, Chung EB, Cavazzana AO (eds): Tumors and Tumorlike Lesions of the Soft Tissues. New York, NY, Churchill Livingstone, 1991, pp 67-89 14. Gray AR, Barker GR: Sublingual lipoma: Report of an unusually large lesion. J Oral Maxillofac Surg 49:747, 1991 15. Kacker A, Taskin M: Atypical intramuscular lipoma of the tongue. J Laryngol Otol 110:189, 1996 16. Lattes R: Tumors of the Soft Tissues. Washington, DC, AFIP, 1981, pp 55-56 17. Das Gupta TK: Tumors of the Soft Tissues. Newark, NJ, Appleton-Century Crofts, 1983, pp 363-368 18. Shirasuna K, Saka M, Watanani K, et al: Infiltrating lipoma of the tongue. Int J Oral Maxillofac Surg 18:68, 1989 19. Weiss SW: Lipomatous tumors. Monogr Pathol 38:207, 1996 20. Minic AJ: Well-differentiated liposarcoma mimicking a pleomorphic lipoma: A case report. J Cranio Maxillofac Surg 21:124, 1993 J Oral Maxillofac Surg 58:819-821, 2000
Pseudoaneurysm of the Superficial Temporal Artery Treated by Embolization: Report of a Case Francisco Sa ´ nchez, MD,* Fernando Delgado, MD,† and Manuel Ramos, MD‡ Pseudoaneurysm of the superficial temporary artery (STA) is an infrequently seen condition, with fewer than 200 cases reported.1 Most of the aneurysms have a traumatic origin, although cases of congenital and arteriosclerotic origin have been described.2 The diagnosis is usually based on the clinical findings and is confirmed by techniques such as duplex ultrasound, computed tomography (CT), or angiography.3-5 In the past, the treatment has been mainly surgical.1,2 We present a case treated by endovascular embolization.
Report of Case A 75-year-old man arrived at the Emergency Service of our hospital after having been involved in a traffic accident; the
Received from the Department of Radiology, Hospital Reina Sofia, Co ´ rdoba, Spain. *Formerly, Fourth-Year Resident of Radiology; Currently, Chief, Department of Radiology, Hospital Alto Guadalquivir, Andu ´ jar, Jae´n, Spain. †Staff Radiologist. ‡Staff Radiologist. Address correspondence and reprint request to Dr Sa´nchez: C/Periodista Fco Javier Cobos 18, Portal 6, 1° E, Granada (18014), Spain; e-mail: [email protected].
r 2000 American Association of Oral and Maxillofacial Surgeons 0278-2391/00/5807-0021$3.00/0 doi:10.1053/joms.2000.7282
diagnosis was fracture of the third and fourth right ribs, fracture of the femoral diaphysis, and left frontal region contusion, with extracranial laceration. A radiograph of the skull showed no fracture lines. Two weeks after the accident, a pulsating, subcutaneous swelling was observed in the area of the frontal contusion. Diagnostic angiography showed a pseudoaneurysm of the STA (Fig 1). Catheterization of the external carotid was performed using a 6F straight guiding catheter GC6/95 (Nycomed, Paris, France); sedation was not required. A Tracker 18 microcatheter and Seeker 16 guide (Target Therapeutics, Freemont, CA) were inserted, and the STA was embolized with two 2 ⫻ 40-mm coils positioned using a size 16 Coil Pusher (Target Therapeutics). This successfully eliminated the aneurysm (Fig 2). At the latest examination, 6 months after embolization, the patient had no symptoms, and the subcutaneous swelling had disappeared.
Discussion An aneurysm of the STA is an infrequent occurrence; only 194 cases have been reported1 since the first description by Bartholin in 1740.6 Most are pseudoaneurysms.4 A real aneurysm has the 3 layers of the artery wall, and a pseudoaneurysm has only a fibrous layer. The pseudoaneurysm is the result of the total or partial rupture of the vessel, organization of the hematoma, and formation of a new wall of fibrous perivascular tissue.3,7 Up to 92% of pseudoaneurysms are of traumatic origin.8 Pseudoaneurysms appear as a pulsating mass in the
Intramuscular Lipoma of the Cheek: A Case Report Adriano Piattelli, MD, DDS,* Massimiliano Fioroni, DDS,† and Corrado Rubini, MD‡ exceedingly rare in the oral cavity, and only 6 cases have been reported.7,8 Four cases were located in the tongue, 1 in the submandibular region, and 1 in the cheek.7 Recently, Bataineh et al9 reviewed 7 previously reported cases of infiltrating lipoma of the oral cavity found in the literature since 1982 and added 3 previously unrecorded cases. Because of its rarity, we report an additional case of intramuscular lipoma of the oral cavity.
Lipoma is a tumor composed exclusively of adipocytes without atypia.1 They account for approximately 1% of all benign tumors of the oral cavity2; however, other investigators believe that lipomas are much more common than has previously been recognized.3 Approximately 220 cases of intraoral lipoma have been reported in the literature.4 Lipoma is different from normal body fat in that its lipids are not available for metabolism, and it has been suggested that this fact, together with its autonomous growth, may warrant its classification as a true benign neoplasm.2 Lipomas usually consist of a demarcated mass in the subcutaneous tissue but also may be less circumscribed, deeply situated lesions involving muscle, nerve, or synovium.1,5 The latter lesions are called intramuscular lipomas or infiltrating lipomas.5 They are comparatively uncommon tumors, and Allen6 reported only 3 cases in approximately 87,000 routine surgical cases. Two varieties of deep-seated intramuscular lipomas have been described: lipomas and angiolipomas.7 The angiolipoma is distinguished from the lipoma by its prominent vascular components8; infiltrating lipomas are composed of mature adipose cells, inconspicuous blood vessels, and delicate strands of connective tissue.9 Infiltrating lipomas are usually located in the limbs.5,8,10-12 Fifty percent are located in the thigh, 20% in the shoulder region and upper arm, 20% in the chest wall, and 10% in other locations.6 They are
Report of Case A 45-year-old man presented with a 4- to 5-cm painless mass in the left cheek (Fig 1) that had been present for 6 months. The lesion was covered by normal-appearing mucosa, seemed to be circumscribed, and it was tethered to the superficial and deeper structures. On palpation, the lesion was firm and nonfluctuant. The lesion was removed under local anesthesia. The removal was difficult, because the lesion was firmly attached to the neighboring soft tissues. The gross appearance was that of an irregular, lobulated, firm, fibrofatty lesion with no evidence of encapsulation (Fig 2). The cut surface was pale yellow. Microscopically, the lesion showed a diffuse infiltration of entrapped striated muscle, with no lipoblasts and a complete absence of cellular atypia (Fig 3). The final microscopic diagnosis was intramuscular lipoma of the cheek. There has been no evidence of recurrence after a 4-year follow-up.
Discussion Tumors of adipose tissue represent the most common form of soft tissue neoplasm in adults, and most lipomatous lesions do not present any particular diagnostic problems.13 Conversely, there exist a group of benign lipomatous tumors, including spindle cell and pleomorphic lipomas, lipoblastoma, and intramuscular lipoma, that may cause considerable diagnostic difficulty and are occasionally mistaken for liposarcomas.13 Oral lipomas usually originate in the submucous fat and can occur in any soft tissue area,3,14 but the cheek and tongue account for about half of published cases. Oral infiltrating lipomas seem to be larger than the ordinary oral lipomas, and they are deep-seated, slowgrowing, generally painless masses that can cause swelling and deformity.5-7 Macroscopically they are well-circumscribed, rounded, and often lobulated tu-
*Professor of Oral Medicine and Pathology, Dental School, University of Chieti, Italy; Honorary Senior Lecturer, Eastman Dental Institute for Oral Health Care Sciences, London, United Kingdom. †Research Fellow, Dental School, University of Ancona, Italy. ‡Researcher, Institute of Pathologic Anatomy and Histopathology, University of Ancona, Italy. Supported by the National Research Council (C.N.R.), Rome, Italy; and by the Ministry of University, Research, Science and Technology (M.U.R.S.T.), Rome, Italy. Address correspondence and reprint requests to Dr Piattelli: Via F Sciucchi 63, 66100 Chieti, Italy; e-mail: [email protected]
r 2000 American Association of Oral and Maxillofacial Surgeons 0278-2391/00/5807-0020$3.00/0 doi:10.1053/joms.2000.7281
817
818
INTRAMUSCULAR LIPOMA OF THE CHEEK
FIGURE 3. Photomicrograph showing diffuse infiltration of the striated muscle tissue. No lipoblasts are present, and there is complete absence of cellular atypia (hematoxylin and eosin, original magnification ⫻200).
FIGURE 1. Lesion of the cheek at the time of first presentation of the patient.
mors.6 The size can vary from small lesions to tumors with a 20-cm or greater diameter.5,6 These tumors present clinical features that often help to distinguish them from other soft tissue tumors, namely, their slow growth, flat appearance, and a soft texture when the surrounding muscle is relaxed11; they appear spherical when the affected muscle contracts.5,6 Usually these tumors are not encapsulated.7,11 On rare occasions, the infiltration is so extensive that it can cause muscle dysfunction or sensory changes because of pressure on nerve trunks7; pain is rarely severe.7 A high rate of recurrences, perhaps attributable to the difficulty in excision, is always associated with these tumors.7,15 In the reported head and neck cases, the recurrence rate has been from 27.3% to 62.5%.10 Microscopically, there is a consistent and diffuse
infiltration with dissociation and entrapment of the muscle fibers, some of which show degenerative changes.7,9,11,16 The muscle tissue is replaced by the fat, which may extend beyond the muscle fascia into the intermuscular connective tissue spaces.5,17 Fascia, joint capsules, bones, and nerves also may be infiltrated.7 Because of the infiltrative nature and potentially high rate of recurrence after inadequate surgery, complete surgical excision is mandatory.10 Recurrence is always attributable to technical error.17 In addition to inadequate excision, a continued proliferation could contribute to the high recurrence rate.9,11,18 All recurrences have shown a histologic appearance similar to that of the original tumor.10 In intramuscular lipoma, the lipocytes are mature, and there are no lipoblasts or cells with atypical nuclei as in a well-differentiated liposarcoma.5,15 Lipoblasts have an eccentric, hyperchromatic nucleus that is indented or scalloped by the presence of 1 or more fat vacuoles.19 Moreover, liposarcomas show myxoid degeneration, pleomorphism, and mitoses.11 Some authors prefer to include the atypical lipomatous lesions among the liposarcomas because of their high recurrence rate, but also because some of them may recur as less differentiated and fully malignant neoplasms.20 However, it must be stressed that it is possible to observe large areas of well-differentiated liposarcoma that are indistinguishable from an intramuscular lipoma.5 The high rate of recurrence casts doubt on the benign histologic pattern.11
References
FIGURE 2. The lesion being removed. It appears as a circumscribed, nonencapsulated, yellow, fatty tumor.
1. Weiss SW: Histological Typing of Soft Tissue Tumors (ed 2). Berlin, Germany, Springer Verlag, 1994, p 23 2. Ghandour K, Issa M: Lipoma of the floor of the mouth. Oral Surg Oral Med Oral Pathol 73:59, 1992 3. Wilson GW, Braun TW, Smith RL: Nodular mass in the anterior floor of the mouth. J Oral Maxillofac Surg 48:492, 1990
´ NCHEZ, DELGADO, AND RAMOS SA 4. Maia Campos G, Grandini SA, Lopes RA: Angiolipoma of the cheek. Int J Oral Surg 9:486, 1980 5. Enzinger FM, Weiss SW: Soft Tissue Tumors (ed 3). St Louis, MO, Mosby, 1995, p 410-412 6. Allen PW: Tumors and Proliferations of Adipose Tissue: A Clinicopathologic Approach. New York, NY, Masson, 1981, pp 7-8 7. Pe´lissier A, Sawaf MH, Shabana AHM: Infiltrating (intramuscular) benign lipoma of the head and neck. J Oral Maxillofac Surg 49:1231, 1991 8. Wilson GW, Braun TW, Smith RL: Nodular mass in the anterior floor of the mouth. J Oral Maxillofac Surg 48:492, 1990 9. Bataineh AB, Mansour MJ, Abalkhail A: Oral infiltrating lipomas. Br J Oral Maxillofac Surg 34:520, 1996 10. Garavaglia J, Gnepp DR: Intramuscular (infiltrating) lipoma of the tongue. Oral Surg Oral Med Oral Pathol 63:348, 1987 11. Akasaka N, Chino T Jr, Chino T, et al: Infiltrating lipoma of the mental region: Report of case. Br J Oral Maxillofac Surg 31:388, 1993
819 12. Sanchez Aniceto G, Salvan Saez R, Garcia Penin A: Angiolipoma of the cheek: Report of a case. J Oral Maxillofac Surg 48:512, 1990 13. Chung ED, Cavazzana AO, Fassina AS: Tumors of adipose tissue, in Ninfo V, Chung EB, Cavazzana AO (eds): Tumors and Tumorlike Lesions of the Soft Tissues. New York, NY, Churchill Livingstone, 1991, pp 67-89 14. Gray AR, Barker GR: Sublingual lipoma: Report of an unusually large lesion. J Oral Maxillofac Surg 49:747, 1991 15. Kacker A, Taskin M: Atypical intramuscular lipoma of the tongue. J Laryngol Otol 110:189, 1996 16. Lattes R: Tumors of the Soft Tissues. Washington, DC, AFIP, 1981, pp 55-56 17. Das Gupta TK: Tumors of the Soft Tissues. Newark, NJ, Appleton-Century Crofts, 1983, pp 363-368 18. Shirasuna K, Saka M, Watanani K, et al: Infiltrating lipoma of the tongue. Int J Oral Maxillofac Surg 18:68, 1989 19. Weiss SW: Lipomatous tumors. Monogr Pathol 38:207, 1996 20. Minic AJ: Well-differentiated liposarcoma mimicking a pleomorphic lipoma: A case report. J Cranio Maxillofac Surg 21:124, 1993 J Oral Maxillofac Surg 58:819-821, 2000
Pseudoaneurysm of the Superficial Temporal Artery Treated by Embolization: Report of a Case Francisco Sa ´ nchez, MD,* Fernando Delgado, MD,† and Manuel Ramos, MD‡ Pseudoaneurysm of the superficial temporary artery (STA) is an infrequently seen condition, with fewer than 200 cases reported.1 Most of the aneurysms have a traumatic origin, although cases of congenital and arteriosclerotic origin have been described.2 The diagnosis is usually based on the clinical findings and is confirmed by techniques such as duplex ultrasound, computed tomography (CT), or angiography.3-5 In the past, the treatment has been mainly surgical.1,2 We present a case treated by endovascular embolization.
Report of Case A 75-year-old man arrived at the Emergency Service of our hospital after having been involved in a traffic accident; the
Received from the Department of Radiology, Hospital Reina Sofia, Co ´ rdoba, Spain. *Formerly, Fourth-Year Resident of Radiology; Currently, Chief, Department of Radiology, Hospital Alto Guadalquivir, Andu ´ jar, Jae´n, Spain. †Staff Radiologist. ‡Staff Radiologist. Address correspondence and reprint request to Dr Sa´nchez: C/Periodista Fco Javier Cobos 18, Portal 6, 1° E, Granada (18014), Spain; e-mail: [email protected].
r 2000 American Association of Oral and Maxillofacial Surgeons 0278-2391/00/5807-0021$3.00/0 doi:10.1053/joms.2000.7282
diagnosis was fracture of the third and fourth right ribs, fracture of the femoral diaphysis, and left frontal region contusion, with extracranial laceration. A radiograph of the skull showed no fracture lines. Two weeks after the accident, a pulsating, subcutaneous swelling was observed in the area of the frontal contusion. Diagnostic angiography showed a pseudoaneurysm of the STA (Fig 1). Catheterization of the external carotid was performed using a 6F straight guiding catheter GC6/95 (Nycomed, Paris, France); sedation was not required. A Tracker 18 microcatheter and Seeker 16 guide (Target Therapeutics, Freemont, CA) were inserted, and the STA was embolized with two 2 ⫻ 40-mm coils positioned using a size 16 Coil Pusher (Target Therapeutics). This successfully eliminated the aneurysm (Fig 2). At the latest examination, 6 months after embolization, the patient had no symptoms, and the subcutaneous swelling had disappeared.
Discussion An aneurysm of the STA is an infrequent occurrence; only 194 cases have been reported1 since the first description by Bartholin in 1740.6 Most are pseudoaneurysms.4 A real aneurysm has the 3 layers of the artery wall, and a pseudoaneurysm has only a fibrous layer. The pseudoaneurysm is the result of the total or partial rupture of the vessel, organization of the hematoma, and formation of a new wall of fibrous perivascular tissue.3,7 Up to 92% of pseudoaneurysms are of traumatic origin.8 Pseudoaneurysms appear as a pulsating mass in the