A Rare Pediatric Case of Posttraumatic Pseudoaneurysm: Case Report and Literature Review.

Posttraumatic pseudoaneurysms are extremely rare in pediatric populations. In many cases, pseudoaneurysms may be confused with abscesses, epidermoid cysts, arteriovenous fistula, foreign objects, and ganglion cysts, as well as tumors. They are associated with distinguishing findings of "pulsatile mass, a palpable thrill, and an audible to-and-fro murmur" (1), which can be confirmed by various imaging techniques. In this report, we describe the case of a 4-year-old boy who presented to the pediatric emergency department 3 weeks after falling and subsequently getting cut by glass. Upon clinical examination, the patient presented with pulsatile, swollen mass in the left wrist. A Doppler ultrasound of the left wrist demonstrated that the area of clinical concern in the left wrist showed a pseudoaneurysm, and prominent arterial blood flow was seen within the pseudoaneurysm. Because pseudoaneurysms, particularly posttraumatic pseudoaneurysms, are extremely rare in the pediatric population, it may be easy to miss these cases during clinical examination. Misdiagnosis of the pseudoaneurysm can cause delayed treatment, a longer recovery period, and complications such as infection, rupture, and hemorrhage. It is important for physicians to consider this entity when evaluating patients with symptoms of asymptomatic bulges to painful pulsatile masses after trauma.

Ultrasound in diagnosis of retroperitoneal femoral nerve injury: a case report.

We present a case of retroperitoneal femoral nerve injury after cut wounds at the lower abdomen. Electrodiagnostic tests revealed impaired function of nerve and muscles. A mass was observed at the retroperitoneal part of the femoral nerve by ultrasound, indicating that a traumatic neuroma composed of disordered fascicles was configurated after the injury. Postoperative pathology confirmed hypertrophic and hyperplastic nerve bundles of the mass. Great improvements were shown in the patient's symptoms and electrodiagnostic tests in the subsequent 3 months. This case presented a rare position of neuroma formation by ultrasound.

Histogenetic and taxonomic considerations on a case of post-traumatic bizarre parosteal osteochondromatous proliferation (BPOP).

A case of bizarre parosteal osteochondromatous proliferation (BPOP) arising in the head of the fibula of a young man following injury on the lateral aspect of the knee is reported. Microscopically, four zones could be recognized proceeding from the periphery to the deep portion: 1) an outer thick fibrous cap showing an abundant cellular component, composed of thin spindled elements of fibroblastic appearance, haphazardly arranged and exhibiting intense and diffuse immunohistochemical expression of S100 protein (a previously unreported observation); 2) an irregular and atypical cartilaginous cap beneath the fibrous cap; 3) a layer of blue bone in which islands of atypical chondrocytes are still present but gradually decreasing, moving towards the deeper areas; 4) a layer of mature bone, pink bone, which is implanted in the skeletal segment (the deep margin is devoid of periosteum). The intratrabecular spaces of blue or pink bone did not contain haematopoietic marrow, but rather a loose myxoid stroma. This case confirms the fact that BPOP can occur in skeletal segments other than those indicated in the original report of Nora, and that trauma, even if minor, is an important factor in the development of the lesion. The latter begins at the periosteal level, where fibroblasts may acquire a chondroformative function (becoming chondrofibroblasts), as witnessed by the strong and widespread expression of P S100, first documented in this report.

The role of high-resolution ultrasound in the diagnosis of a traumatic neuroma in an injured median nerve.

Since the development of high-resolution ultrasound, its role in the diagnosis of peripheral nerve lesions has steadily increased. We present the case of a 42-yr-old woman who experienced consistent numbness over the left hand and fingers after cutting the wrist in a suicide attempt and subsequent tendon and median nerve repair and a period of rehabilitation. Electrodiagnostic testing was normal, but high-resolution ultrasound demonstrated hypoechoic, focal swelling in the region of the median nerve consistent with a neuroma. Neuroma was confirmed at surgery, and after excision of the neuroma, nerve repair with a nerve graft was performed. Postoperatively, the patient's symptoms improved significantly. This case suggests that high-resolution ultrasound may be superior to electrodiagnostic studies for the diagnosis of traumatic neuroma.

Traumatic neuroma after neck dissection: CT characteristics in four cases.

BACKGROUND AND PURPOSE: Traumatic neuroma, an attempt by an injured nerve to regenerate, may present as a palpable nodule or an area sensitive to touch (trigger point) after neck dissection. The purpose of this study was to identify CT characteristics of traumatic neuroma in four patients after neck dissection. METHODS: Between April 1995 and November 1998, the CT studies in three men and one woman (ages, 45-64 years) who had had a radical neck dissection and a nodule posterior to the carotid artery were reviewed retrospectively. CT was performed 1.5 to 6 years after neck dissection with clinical correlation and/or pathologic examination. Three patients had squamous cell carcinoma of the upper aerodigestive tract and one had a primary parotid adenocarcinoma. RESULTS: Three patients with a traumatic neuroma had a centrally radiolucent nodule with peripherally dense rim and intact layer of overlying fat, which was stable on CT studies for 1 to 2 years. One of these had a clinical trigger point. The fourth patient with a pathologically proved traumatic neuroma mixed with tumor had intact overlying fat, but the nodule lacked a radiolucent center and was not close to the carotid artery. CONCLUSION: The CT findings of a stable nodule that is posterior but close to the carotid artery with central radiolucency, a dense rim, and intact overlying fat, combined with the clinical features of a trigger point and a lack of interval growth, strongly suggest the diagnosis of traumatic neuroma.

Osteolipoma of the hand: a case report.

A 61-year-old, healthy woman presented with a six-month history of a mass on the radial volar aspect of her dominant right hand. The patient had a history of trauma to the hand six years previously. Radiographs showed a bony lesion in the index metacarpal shaft and the MRI showed a bony lesion and soft tissue mass suggestive of a parosteal lipoma. Surgical excision of the lesion revealed a lipoma overlying a bony exostosis or osteolipoma of the hand. Post-operatively, the patient's symptoms resolved and she had no recurrence of the tumor.

Osteoid osteoma after a fracture of the distal radius.

We report a case of osteoid osteoma occurring at the site of a previous fracture of the radius treated by internal fixation with insertion of a rod. The fracture may have acted as a trigger for the formation of an osteoid osteoma.