Traumatic pseudoaneurysm of the superficial temporal artery after paintball injury.

A 16 year old male presented to Hadassah Medical Center with a 6 month history of a slowly growing mass on his right lateral forehead, which rapidly arose hours after he had been shot during a paintball game. The nodular mass presented focal tenderness, and a focal post-traumatic scalp hematoma was suspected. After a couple of months the nodule was asymptomatic, but instead of shrinking, it became enlarged, causing cosmetic concern. Examination revealed that it was pulsatile [Figure A]. Doppler ultrasound confirmed the vascular nature of the subcutaneous mass. Contrasted head computed tomography showed the dense contrast opacification of the frontal mass. The frontal bone was normal and no intracranial abnormalities were detected. After considering the P aintball is a game in which players compete, in teams or individually, to eliminate opponents by hitting them with pellets containing paint (referred to as a paintball) from a special gun called a paintball marker. This game has been gaining popularity since the early 1980s worldwide. A primary health concern has been the risk of injury to the eye; numerous case studies have reported on ocular injuries resulting from a projected paintball [1,2]. To prevent ocular injuries, goggles should be worn at all times during the game. It has been shown that with this sole measure, ocular injuries have declined substantially [2,3]. Traumatic pseudoaneurysm of the scalp arteries is a very uncommon complication of blunt head trauma and has been exceptionally described in associadifferent therapeutic options and patient preference, endovascular treatment was recommended. Under local anesthesia, a 5 F introducer sheath was placed at the right femoral artery under ultrasound guidance. A guiding catheter was placed at the origin of the external carotid artery [Figure B]. Co-axially, a microcatheter was navigated through the frontal branch of the superficial temporal artery and placed immediately proximal to the pseudoaneurysm [Figure C]. Detachable coils were deployed at this level, completely occluding the vessel and the pseudoaneurysm [Figure D]. Doppler ultrasound examination after 12 hours showed absence of flow into the lesion. At 2 months follow-up, the forehead nodule presented a marked shrinkage and was not readily visible.