A superficial temporal artery pseudoaneurysm following dog bites in a 4-year-old child: The first case reported in the literature

Abstract

Pseudoaneurysms of the extracranial arterial system are rare, largely due to the small size and thin walls of superficial vessels. This report presents a case of a pseudoaneurysm of the superficial temporal artery (STA) following dog bites in a 4-year-old child, an injury sustained three months prior. The lesion was initially misdiagnosed as an abscess, possibly involving an occult foreign body, and was unsuccessfully drained in the Emergency Department (ED). Physical examination revealed a palpable mass measuring 21 x 18 x 12 mm in the left frontotemporal region above the eyebrow. There were no signs of local inflammation or fluctuation. The child's facial expressions and eyebrow movements were normal, and laboratory tests were within normal limits. Doppler ultrasound demonstrated a partially thrombosed pseudoaneurysm with a well-defined swirl pattern, known as the yin and yang sign. The patient was admitted for surgery, and the frontal branch of the superficial temporal artery was dissected to the neck of the pseudoaneurysm after debridement and removal of blood clots. A pseudoaneurysm measuring approximately 1 cm in diameter was observed on the deep side of the lesion, extending up to the eyebrow. The affected artery was ligated using a segmental running locking suture and then excised. Postoperatively, the patient was transferred to the clinic in stable condition without complications. Pathological analysis revealed that the tumor wall consisted of a mixed thrombus with signs of organization. The patient experienced no complications during follow-up. It is of utmost importance to obtain a comprehensive clinical history, conduct a meticulous physical examination, and perform detailed imaging studies, including ultrasound, to avoid overlooking critical pathologies in emergency situations. Such measures are essential for early detection and management of underlying medical conditions, thereby preventing further complications and improving the overall prognosis.