Introduction: Pseudoaneurysm of the deep palmar archis a rare entity, with only few cases described in the literature. A high index of suspicion is necessary for the diagnosis and treatment. Below we present a case of a pseudoaneurysm of the deep palmar arch in an18-year-oldman following a sharp cut injury over the dorsum which was treated surgically in our department.

Case Report: An18-year-old man, right-handed, reported to our department with a swelling over the dorsum of left hand, following accidental trauma to the dorsum with a knife that was sutured locally one month ago. Swelling was insidious in onset, gradually progressed to the present size. On clinical examination, a scar visible over the dorsum, non-tender, pulsatile swelling of 3cms x 5 cms x 4cms under the scar, overlying skin freely mobile, radial and ulnar pulses were well felt, no signs of distal ischemia in the fingers, no sensory changes present. Plain radiograph of the left hand was normal. MRI revealed a 2.2 x 4.6 x 3.2 cms pseudoaneurysm deep to extensor tendons, third and fourth metacarpal bones with branch of radial artery in close proximity. Digital subtraction angiography did not show any blush or filling up of the pseudoaneurysm. On Surgical explorationthe Pseudoaneurysm was found to be thrombosed and excised in toto. The scar healed well and patient had no complications.

Conclusion: Pseudoaneurysm of the palmar arch after local penetrating trauma is an important differential for patients presenting with palmar or dorsal masses. Pseudoaneurysm can be effectively diagnosed and treated surgically with excellent results.

Keywords: Pseudoaneurysm, deep palmar arch, Digital subtraction angiography.

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Dr Amarnath Munoli

4^th Floor Room Number 450 College Building Department of Plastic Surgery Sion Hospital Mumbai 400022