Surgical resection cures pseudoaneurysms in most cases. The frontal and zygomatic branches of the facial nerve are at risk during this procedure. Local sclerosis is effective but may cause distal tissue necrosis. Coil embolization is highly effective and leaves no facial scar but carries small risks of stroke, lower extremity ischemia, and groin pseudoaneurysm.

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D evelopment of a symptomatic post-traumatic pseudoaneurysm following a gun shot wound, in the absence of initial signs of vascular injury such as active bleeding, loss of pulses, and enlarging hematoma, is uncommon. We present an 18-year-old man sustaining a single, through-and-through gun shot wound to the right thigh. Physical examination revealed a single entrance wound in the posterior-lateral region of the thigh and an exit wound in the anterior-lateral region. The patient had palpable pulses distally and symmetric ankle-brachial indices that were normal. Plain film radiographs revealed no evidence of fracture. The patient was admitted for observation (serial neurovascular exams of the right leg) and discharged the next day without any change in his clinical condition.The patient was readmitted 19 days later with complaints of pulsatile bleeding from his exit wound. The patient was noted to have right lateral thigh swelling that was non-pulsatile and without bruits. The neurovascular examination was unremarkable. Real-Time color-flow ultrasound revealed a well circumscribed collection with contrasting bands of arterial and venous flow typical for a pseudoaneurysm-the "yin-yang" sign ( Fig. 1). A subsequent arteriogram confirmed the pseudoaneurysm with vascular supply from a muscular branch of the superficial femoral artery and a distal branch of the profunda femoris artery (Fig. 2). These vessels were embolized with coils by interventional radiology, and a repeat arteriogram showed cessation of flow within the pseudoaneurysm (Fig. 3). A follow-up ultrasound on the next day confirmed the absence of flow, and the patient was discharged to home. He has not had any further bleeding. Fig. 1. Real-Time color-flow ultrasound demonstrating arterial and venous flow in the pseudoaneurysm (the "yin-yang" sign).Fig. 2. Arteriogram demonstrating the pseudoaneurysm with vascular supply from a muscular branch of the superficial femoral artery and a distal branch of the profunda femoris artery.Fig. 3. Repeat arteriogram showing cessation of flow within the pseudo-aneurysm following embolization with coils.