Pediatric craniofacial pseudoaneurysm with a variable history of antecedent trauma

A pseudoaneurysm (PA) is a vascular lesion occurring along an artery most often associated with previous trauma. It presents clinically as a compressible, pulsatile mass, which can be painful, growing, and associated with headaches. We report a series of 4 pediatric patients referred for management of a "cyst" who had superficial craniofacial PAs arising in a variety of different locations with a variable history of antecedent trauma.This is an institutional review board-approved study of 4 consecutive patients presenting to the pediatric plastic surgery division with a diagnosis of PA between July 2012 and November 2013.The patients were initially referred for management of cyst. Each presented with compressible, pulsatile masses arising in varying locations along the superficial temporal or occipital arteries of the face and scalp. Three of the patients did not have a history of recent previous trauma. In the patients without history of trauma, further workup with duplex ultrasound was performed. In cases where the entire course of the artery could not be visualized by ultrasound, magnetic resonance angiography was performed to rule out an intracranial source of the lesion. Three lesions were excised with pathologic confirmation of the diagnosis of PA. All masses and associated symptoms resolved after the excision.Craniofacial PAs can occur in the pediatric population with a variable history of antecedent trauma. Awareness of this clinical phenomenon can help guide proper diagnosis for planning of safe, effective treatment. Surgical excision provides a safe, aesthetic result.