Diagnosis of a facial artery pseudoaneurysm using emergency bedside ultrasound

Abstract

Background: Pseudoaneurysms of the extracranial arterial system are rare. We report a case of a facial artery pseudoaneurysm initially mistaken for an abscess. With bedside ultrasound performed in the Emergency Department (ED) by the treating physician, the mass was identified as a pseudoaneurysm.

Objectives: In this report we review the anatomy of the extracranial arterial system of the head and neck, discuss the pathogenesis and clinical presentation of pseudoaneuryms, and present diagnostic imaging and treatment options for pseudoaneurysms of the face.

Case report: A 51-year-old man presented with facial swelling and pain at the site of a laceration that he had sustained 1 month previously. Before incision and drainage, bedside ultrasound was performed in the ED by the treating physician to confirm the presumptive diagnosis of abscess with possible foreign body. The ultrasound revealed the mass to be a pseudoaneurysm.

Conclusions: Although pseudoaneurysms of the head and neck are rare, a history of trauma should prompt the consideration of a vascular injury with the need for imaging before drainage procedures of a presumed abscess. To our knowledge, the use of clinician-performed bedside ultrasound to detect facial artery pseudoaneurysms has never been reported.