title: Posttraumatic lingual artery pseudoaneurysm treated with ultrasound-guided percutaneous thrombin injection.
abstract: Pseudoaneurysms of the lingual artery are extremely rare and are commonly iatrogenic in nature or less frequently a result of blunt or penetrating trauma. Traditionally, these vascular abnormalities have been repaired with open or endovascular techniques. Although ultrasound-guided percutaneous thrombin injection has become a standard treatment for superficial pseudoaneurysms, there are no reports of this being used in the treatment of lingual artery pseudoaneurysms. We report the case of a 26-year-old man who suffered a penetrating head and neck injury after an improvised explosive device blast in Iraq who presented with persistent oropharyngeal swelling. Color-flow Doppler ultrasonography revealed the classic yin/yang sign of a pseudoaneurysm, and a computed tomography scan was obtained that revealed a right lingual artery pseudoaneurysm. With the lack of endovascular capabilities and the excessive risk of open surgery, thrombin was injected directly into the pseudoaneurysm under ultrasound guidance. A computed tomography scan and Doppler ultrasonography revealed complete resolution of the aneurysm. This article presents the first reported case in the English literature of a lingual artery aneurysm after penetrating trauma managed successfully with ultrasound-guided percutaneous thrombin injection.
authors.affiliation: Department of General Surgery, Tripler Army Medical Center, Honolulu, HI. Electronic address: pamela.c.masella.mil@mail.mil.
authors.forename: Pamela C
authors.initials: PC
authors.lastname: Masella
authors.affiliation: Department of General Surgery, Tripler Army Medical Center, Honolulu, HI.
authors.forename: Megan M
authors.initials: MM
authors.lastname: Hanson
authors.affiliation: Department of Emergency Medicine, Darnall Army Medical Center, Fort Hood, TX.
authors.forename: Brian T
authors.initials: BT
authors.lastname: Hall
authors.affiliation: Department of Cardiothoracic Surgery, Tripler Army Medical Center, Honolulu, HI.
authors.forename: John J
authors.initials: JJ
authors.lastname: Verghese
authors.affiliation: Department of Vascular Surgery, Tripler Army Medical Center, Honolulu, HI.
authors.forename: Dwight C
authors.initials: DC
authors.lastname: Kellicut
mesh_terms: D000007:Abdominal Injuries / Q000150:complications* / Q000175:diagnosis; D000328:Adult; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D057510:Endovascular Procedures / Q000379:methods*; D006490:Hemostatics / Q000008:administration & dosage; D006801:Humans; D007267:Injections; D008297:Male; D013917:Thrombin / Q000008:administration & dosage*; D018615:Ultrasonography, Doppler, Color / Q000379:methods*; D018084:Ultrasonography, Interventional
chemical_list: D006490:Hemostatics; D013917:Thrombin