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Imaging Features of Pseudoaneurysms of the Hand in Children and Adults

S. E. Anderson1, D. De Monaco2, U. Buechler3, J. Triller1, U. Gerich3, M. Dalinka4, E. Stauffer5, L. Nagy3, A. Niedecker6, R. Campbell7, P. A. Araoz8 and L. S. Steinbach8

1 Department of Radiology, University Hospital of Bern, Inselspital, CH-3010 Bern, Switzerland.
2 Department of Plastic and Reconstructive Surgery, Kantonspital Aarau, 5000 Aarau, Switzerland.
3 Department of Orthopedics, University Hospital of Bern, Inselspital, CH-3010 Bern, Switzerland.
4 Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104.
5 Department of Pathology, University Institute of Bern, Inselspital, CH-3010 Bern, Switzerland.
6 IMAMED Radiologie Nordwest, 4058 Basel, Switzerland.
7 Department of Radiology, The James Cook University Hospital, Middlesborough, TS4 4BW United Kingdom.
8 Department of Radiology, University of California San Francisco, San Francisco, CA 94143.



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  		Fig. 1A. —36-year-old man who presented with soft-tissue mass suspicious for malignant tumor. Volar coronal T1-weighted MR image (TR/TE, 480/16) obtained at level of pisiform (asterisk) shows low-signal-intensity ulnar pseudoaneurysm within Guyon's canal; pseudoaneurysm measures 20 x 15 mm. Proximal and distal ulnar arteries (black arrows) and thickened saccular wall (white arrow) can be seen.

 


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  		Fig. 1B. —36-year-old man who presented with soft-tissue mass suspicious for malignant tumor. Axial MR image obtained from two-dimensional time-of-flight MR angiogram (28/6.9; flip angle, 60°) shows ulnar pseudoaneurysm arterial flow (arrow).

 


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  		Fig. 1C. —36-year-old man who presented with soft-tissue mass suspicious for malignant tumor. Photomicrograph of histologic gross specimen of pseudoaneurysm shows thinned adventitia (arrows) and absence of intima and media. (H and E, x6)

 


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  		Fig. 2A. —20-year-old man who presented with mass and symptoms of hypothenar syndrome. Digital subtraction angiogram shows occlusion of ulnar artery (large arrow) in region of Guyon's canal with thromboemboli (small arrows) in digital artery branches.

 


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  		Fig. 2B. —20-year-old man who presented with mass and symptoms of hypothenar syndrome. Sagittally oriented sonographic image shows thrombosis (arrows) of ulnar artery pseudoaneurysm.

 


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  		Fig. 2C. —20-year-old man who presented with mass and symptoms of hypothenar syndrome. Intraoperative photograph shows ulnar artery pseudoaneurysm in isolation. Pseudoaneurysm measured 10 x 8 mm.

 


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  		Fig. 2D. —20-year-old man who presented with mass and symptoms of hypothenar syndrome. Photograph shows transected specimen with central thrombosis.

 


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  		Fig. 2E. —20-year-old man who presented with mass and symptoms of hypothenar syndrome. Photomicrograph shows anatomic specimen of pseudoaneurysm with thickened wall (arrows) and central thrombosis (asterisk). (H and E, x3)

 


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  		Fig. 3A. —55-year-old woman who presented with recurrent swelling and hemarthrosis associated with chronic nonunion of scaphoid. Digital subtraction angiogram shows small 3-mm radial pseudoaneurysm (arrow) at level of nonunion of scaphoid.

 


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  		Fig. 3B. —55-year-old woman who presented with recurrent swelling and hemarthrosis associated with chronic nonunion of scaphoid. Photomicrograph of gross specimen of radial pseudoaneurysm shows arterial wall defect (arrows) with thrombus. (H and E, x25)

 


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  		Fig. 4A. —13-year-old boy who presented with enlarging mass. Axial T2-weighted MR image (TR/TE, 2700/80) shows radial pseudoaneurysm with central flow void. Pseudoaneurysm measured 18 x 15 mm.

 


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  		Fig. 4B. —13-year-old boy who presented with enlarging mass. Oblique maximal-intensity-projection MR image obtained from three-dimensional contrast-enhanced MR angiogram shows direct communication of pseudoaneurysm with radial artery, proximally and distally (arrows).

 


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  		Fig. 5A. —26-year-old man who plays American football professionally. Patient presented with mass suspicous for malignant tumor. Axial T1-weighted MR image (TR/TE, 500/14) shows focal high-signal-intensity mass (arrow) in neurovascular bundle between adductor pollicis longus, flexor pollicis longus, and flexor radialis tendons. Mass measured 10 x 27 mm.

 


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  		Fig. 5B. —26-year-old man who plays American football professionally. Patient presented with mass suspicous for malignant tumor. Axial T2-weighted MR image (3550/60) shows high-signal-intensity mass (arrow).

 


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  		Fig. 5C. —26-year-old man who plays American football professionally. Patient presented with mass suspicous for malignant tumor. Gadolinium-enhanced T1-weighted fat-suppressed MR image (700/14) shows heterogeneously enhancing mass (arrow). MR angiogram (not shown) confirmed diagnosis of pseudoaneurysm.

 

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