A case of cirsoid aneurysm of the scalp

Abstract

SURGICAL REGISTRAR, WESTMINSTER HOSPITALT. H., male, aged 45 years, lorry driver, admitted December 18, 1936. HISTORY.-h I914 a small soft swelling was first noticed on the right side of the head, and this had gradually increased in size since that time. The lump was quite painless until ten days ago when, in attempting to stand upright, he struck his head against an iron girder in the roof of his lorry. Following this, the swelling was painful for five or six days and began to grow more rapidly. He had never suffered from headaches or felt any throbbing in the head. There was never any discoloration of the skin noticed, or bleeding from the lump. When aspirated by his doctor after the recent injury, however, bright blood was withdrawn. He had had no treatment, his eyesight was normal, and there were no other symptoms.PHYSICAL EXAMINATION.-GrOWth of hair on the scalp was thinner in the part involved by the tumour. After shaving, an irregular lump, roughly triangular in shape, was to be seen occupying the right temporal and frontal regions. The border of the tumour correspondmg to the base of the triangle was 2 in. long and just transgressed the midline. The apex was directed laterally and forwards, and became continuous with the tortuous and very prominent superficial temporal artery (Fig. 625). In its longest transverse diameter the lump measured 29 in. Its surface was raised about $in. above the general level of the scalp, but just behind the middle of the tumour it projected I in. above the general level, and again near the apex its surface was elevated nearly I in. The postero-lateral border of the tumour followed roughly the line of the fronto-parietal suture, and about its middle was a small prolongation of the tumour along the posterior auricular vessels.Close scrutiny of the shaven scalp failed to reveal any sign of recent or old trauma, and the colour of the skin overlying the tumour was normal. The whole swelling was seen and felt to pulsate synchronously with the pulsation in the superficial temporal artery. On palpation the lump was extremely soft and easily compressible, but on releasing the pressure it immediately returned in a symmetrical fashion to its original size; lowering the head and straining seemed slightly to increase its prominence. The peculiar softness of the tumour gave an impression to the examining fingers similar to that of a depressed fracture.Four groups of vessels were seen running into the tumour. The right superficial temporal artery was principally involved. Its course was plainly outlined and appeared to be a very tortuous one. As can be seen from the drawing, the artery approached the tumour by a very circuitous pathway. The wall of the vessel was soft, and when its lumen was obliterated by digital pressure, pulsation in the tumour promptly ceased, it diminished slightly in size, and refilled only very slowly when emptied. Other vessels to assist in supplying the lump were the right posterior auricular, the right supra-orbital, and the left superficial temporal arteries, ...

Arteriovenous Aneurysms of the Scalp and Face

“…The following are good examples : Müller (1891) 6 described a case in which after operative death the tremendous coils were dissected and photographed; this gave an excellent view of the naked vessels. From England, Canada and Australia, cases have been reported by Brodie (1929),3 Parker (1904), 11 Searby (1931),12 Clunie (1936) 13 (aneurysms restricted to the parietal region of one side), Rundle (1938) 14 (aneurysms restricted to the forehead), Davies-Colley (1940) 15 (mass covered the forehead, nose and left eye) and Patey (1942) 16 (mass was largely in occiput) ; a roentgenogram of one of the enormous vessels was made after injection with iopax (uroselectan). From Germany, large deforming aneurysms were reported by Clairmont (1908), 8 Kepler (1912) 9 and Schlochetzki (1933) 10 and from Holland by Noordenbos and Jong (1918).…”