Spontaneous Pseudoaneurysm of the Proximal Occipital Artery Presenting as a Neck Mass

Article information

Arch Plast Surg. 2017;44(3):249-250

Publication date (electronic) : 2017 May 22

doi : https://doi.org/10.5999/aps.2017.44.3.249

Tae Gon Kim¹, Jin Ho Lee¹, Kyu Jin Chung¹, Jun-Ho Lee¹, Yong-Ha Kim¹, Chul Hoon Chang²

¹Department of Plastic and Reconstructive Surgery, Yeungnam University College of Medicine, Daegu, Korea.

²Department of Neurosurgery, Yeungnam University College of Medicine, Daegu, Korea.

Correspondence: Tae Gon Kim. Department of Plastic and Reconstructive Surgery, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu 42415, Korea. Tel: +82-53-620-3483, Fax: +82-53-626-0705, kimtg0919@hanmail.net

Received 2017 February 23; Revised 2017 March 28; Accepted 2017 March 28.

Occipital artery pseudoaneurysms are rare vascular lesions, and are most often reported as a consequence of trauma [12]. We report the rare case of a spontaneous pseudoaneurysm of the proximal occipital artery that presented as a neck mass.

A 44-year-old male patient presented with a pulsatile swelling lesion in the neck that had grown spontaneously over the course of a year (Fig. 1). The swelling had gradually progressed, and he had no previous history of head trauma, infection, or a genetic disorder. The patient was found to have a firm, non-tender, pulsating mass in the left side of the neck that measured 4×3 cm. Ultrasonography showed turbulent flow and dilatation of the involved vessel. Neck computed tomography showed partial opacification of the swelling and revealed a pseudoaneurysm arising from the left proximal occipital artery (Fig. 2). The decision was made to embolize the lesion via angiography (Fig. 3). The mass was treated successfully by endovascular coil embolization (Fig. 4). One year postoperatively, the swelling had improved and recurrence was not detected.

Fig. 1

Preoperative photograph showing a lesion on the left neck.

Fig. 2

Computed tomography scan (axial section) shows a left proximal occipital artery pseudoaneurysm.

Fig. 3

Computed tomographic angiogram showing the pseudoaneurysm along the course of the proximal occipital artery. A, anterior; P, posterior.

Fig. 4

Angiogram showing the afferent feeding vessel and pseudoaneurysm treated with endovascular coil embolization.

Most occipital artery pseudoaneurysms are consequences of trauma, or are secondary to infections or a genetic disorder [3]. There have been no previous reports of a spontaneous pseudoaneurysm of the occipital artery presenting as a neck mass. The diagnosis can be made based on a thorough history, the exclusion of other possibilities, and imaging studies. Currently, computed tomography angiography is regarded as the most definitive noninvasive diagnostic tool. The advantages of treatment include a reduced risk of hemorrhage, pain relief, and alleviation of cosmetic disfigurement. Treatment options include surgical excision, ligation of the feeding artery, trapping of the pseudoaneurysm, and endovascular arterial embolization and coil occlusion [3].