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21-Year-Old Male With Painless Swelling on Left Temple

Can you diagnose this case?

Schmiedecke RF. Consultant. 2018

Signs and Symptoms

A 21-year-old man presented with a 7-mm painless swelling on the left temple, which had developed after his participation in a paintball game 2 weeks previously. The lesion had not changed in size since its appearance.

What’s your diagnosis?

Choose one to reveal diagnosis and discussion

Epidermoid cyst
Lipoma
Other soft tissue mass
Superficial temporal artery pseudoaneurysm (STAP)

Answer: Superficial temporal artery pseudoaneurysm (STAP)

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The differential diagnosis included epidermoid cyst, lipoma, and other soft tissue mass. On physical examination, the mass was slightly pulsatile and compressible, leading to a diagnosis of superficial temporal artery pseudoaneurysm (STAP).

STAPs typically occur as a result of blunt trauma to the superficial temporal artery (STA) and are usually painless or have mild associated symptoms.1 Pseudoaneurysms form due to contained bleeding within a vessel following minor trauma.1 Similar cases have been described in literature subsequent to paintball injuries when an individual was not wearing proper protective equipment such as a full face shield; they also have been reported in participants in sports with high-momentum strikes, such as helmeted lacrosse players.2,3

A definitive diagnosis and specific location may be achieved with Doppler ultrasonography.1-4 Treatment often requires surgical excision, embolization, or obliteration of the affected vessel.4 Nine months after presentation, this patient’s lesion had fully resolved due to the use of regular compression given the convenient location of the anterior branch of the STA directly beneath the band of a ball cap, suggesting compression as a less-invasive alternative treatment option in some cases.

References
    1. Rood LK. Superficial temporal artery pseudoaneurysm presenting as a suspected sebaceous cyst. J Emerg Med. 2016;51(6):e149-e150.
    2. Baker CR, Sajjanshetty M, Baroni ML, Law N. Paintball injury causing temporal artery pseudoaneurysms—a case for better protection. Injury Extra. 2008;39(1):36-37.
    3. Tracy A, Klinge P, Morrison J, Jayaraman MV, Kriz PK. Traumatic superficial temporal artery pseudoaneurysm in a helmeted lacrosse player. Curr Sports Med Rep. 2016;15(1):13-15.
    4. Younus SM, Imran M, Qazi R. Superficial temporal artery pseudoaneurysm: a case report. Front Surg. 2015;2:51.