Congenital Aneurysm of the Common Digital Artery: Case Report and Literature Review
Erik S Marques, MD; Riley A. Dean, BS; Shannon I. Fleming, BA; Rodrick C. Zvavanjanja, MD; Matthew R. Greives, MD
University of Texas Health Science Center- Houston / McGovern Medical School, Houston, TX
Introduction: Arterial aneurysms of the hand are uncommon but are well-described in the adult population, usually in the setting of chronic, repetitive blunt trauma to the ulnar artery (hypothenar hammer syndrome). However, congenital aneurysms or true aneurysms of the hand are exceptionally rare in the pediatric population.
Methods: We document a case involving a 13-month-old healthy boy without a history of trauma who presented with an enlarging, pulsatile mass of the right palm. Arterial angiography demonstrated an aneurysm of the common digital artery (middle/ring) just distal to its takeoff from the superficial palmar arch. We also conducted a literature search of reported cases of congenital or true arterial aneurysms of the hand in the pediatric population.
Results: The patient underwent operative exploration utilizing the operating microscope. The common digital nerve (middle/ring) was adherent to the outer wall of the aneurysm and required meticulous dissection. A 1.5 cm aneurysm of the common digital artery (middle/ring) was excised. Following resection, the tourniquet was deflated and there was prompt restoration of perfusion to all of the fingers. There was pulsatile back-bleeding after release of the microvascular clamp controlling the distal portion of the common digital artery. Microvascular reconstruction was not required. Microscopic examination of the resected specimen was consistent with a (true) congenital arterial aneurysm. The patient recovered well from the procedure with full hand function.
During our literature search, we found 10 documented cases of congenital or true arterial aneurysms of the hand in the pediatric population. Patient age ranged from 5 months to 15 yrs (mean= 6 yrs). None of the patients had a history of trauma. None had a history of hereditary collagen disease (Ehlers Danlos, Marfan's Syndrome) or Kawasaki disease. Locations of the aneurysms included: ulnar artery (n=8), superficial palmar arch (n=1), and palmar digital artery (n=1). In all cases, management consisted of operative exploration and aneurysm excision. Arterial reconstruction was performed in 5 cases.
Conclusion: There are very few cases in the literature documenting congenital or true arterial aneurysms of the hand in the pediatric population. The ulnar artery is most commonly involved. The management strategy of aneurysm excision is consistent amongst the cases. Microvascular reconstruction becomes mandatory in cases where there is inadequate collateral circulation following aneurysm excision. Our patient adds to the existing body of literature and represents one of the only reported cases of a congenital true aneurysm originating from the common digital artery.
Back to 2018 ePosters