A 79-year-old man who came to a general surgical clinic for evaluation of his asymptomatic bilateral inguinal herniae was noticed incidentally to have a swelling over his right temporal bone (Figure 1). The patient had injured his head 6 weeks previously following a fall, and this was thought by the GP to be a small haematoma that would eventually settle. Since then, the swelling had progressively become larger and tender. On examination, he had a 3 cm diameter pulsatile mass over his temporal bone, which on clinical grounds represented a superficial temporal artery pseudoaneurysm. With the view that the aneurysm was likely to enlarge and rupture, it was arranged for the patient to undergo an urgent operation to remove it. A cervical block supplemented by 10 ml 1% lignocaine locally was used as the patient was unfit for a general anaesthetic. A transverse incision was made just anterior to the tragus in order to ligate the superficial temporal artery, thus gaining proximal control of the blood supply to the pseudoaneurysm. Excision of the pseudoaneurysm (Figure 2) was then undertaken through a second elliptical incision over the swelling. Distal ligation was not required as the lumen of the superficial temporal artery was obliterated. The patient recovered well from the operation and was discharged on the same day.

No abstract