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BACKGROUND
True aneurysms of the superficial temporal artery (STA) are quite uncommon, though Bartholin described an STA pseudoaneurysm (psA) as early as 1740. 1 Only 14 such cases are described in the literature, Martin et al being the first to document a histologically confirmed true STA aneurysm (STAA) in 1955. 2 We report a symptomatic true STAA that was mistaken for a sebaceous cyst and discuss the presentation and management.
CASE PRESENTATION
An 80-year-old female presented with a painful swelling in the right temporal region of 3 weeks duration. There was no past history of trauma. This was initially treated as an infected sebaceous cyst with a course of oral antibiotics. Specialist referral was prompted by acute exacerbation of right temporal pain and a short fainting spell.
Clinical examination revealed a non-tender 1x1 cm lump in the right temporal region with expansile pulsation, mobile only along the vertical axis ( fig 1A ). Cardiovascular and neurological examination was unremarkable. Examination of the limb vasculature and the abdomen did not reveal any obvious aneurysms.
INVESTIGATIONS
The patient underwent an ultrasound scan (USS), which demonstrated a 10 mm (length) by 8 mm (diameter) STAA arising at its bifurcation ( fig 1B ).
DIFFERENTIAL DIAGNOSIS
Sebaceous cyst
Haematoma
Angiofibroma
Eroding middle meningeal artery aneurysm
Parotid mass
TREATMENT
The aneurysm was excised under general anaesthetic ( fig 2A ).
OUTCOME AND FOLLOW-UP
Histology revealed features consistent with a true aneurysm; a combination of H&E and elastin van Gieson stains demonstrated a paucity of muscle and elastic fibres ( fig 2B ). A magnetic resonance angiogram (MRA) of her cranial vasculature revealed no further aneurysms. The postoperative period was uneventful and she was discharged the same day. She was well on outpatient follow-up.
DISCUSSION
About 95% of the 300 and more cases of STAAs reported in the world literature are post-traumatic psAs. 3 Only the remaining 5% are true aneurysms, with one report of multiple STAAs in the same patient. 4 The literature is confusing as there are several case reports referring to post-traumatic psAs simply as "aneurysms" 5 (which have led some authors to mistake Bartholin's report as pertaining to true aneurysm formation), 3 and also some authors reporting a...