Answer for BIR CoW 23 Jun 2024
CIRSOID ANEURYSM OF THE SCALP
Findings
Contrast MR Angiogram reveals dilated tortous vessels in the midline subcutaneous frontal region fed by branches of bilateral superficial temporal artery and drained by bilateral superior ophthalmic, facial and superficial temporal veins No evidence of intracranial extension of the malformation Impression: The clinical image and the radiological findings are consistent with cirsoid aneurysm of the scalp
Discussion
Cirsoid means resembling a varix – referring to the characteristic variceal dilatation of the draining veins
They have been previously referred to as aneurysma serpentinum or aneurysma racemosum
Occurs due to abnormal vascular connections (arterio-venous shunts) within the scalp between the branches of external carotid artery and the scalp veins. It can either congenital or traumatic in origin
Most common feeder-Superficial temporal artery
Clinical presentation: Gradually progressive pulsatile scalp swelling. Progressive cosmetic deformity
Investigations: Gold standard- Invasive Angiography to delineate the lesion ,exclude an intracranial component and for therapeutic benefits CT and MR Angiogram - Non invasive ,hence often preferred ,and also useful to exclude differential diagnoses
Treatment: Surgical excision, endovascular occlusion, and direct percutaneous injection of sclerosing agents.
Differential diagnosis:
1.Calvarial vascular malformations, 2.Traumatic aneurysm of the superficial temporal artery 3.Scalp hemangiomas, and 4.Vascular malformations with both intra and extracranial components such as sinus pericranii.
Findings
Contrast MR Angiogram reveals dilated tortous vessels in the midline subcutaneous frontal region fed by branches of bilateral superficial temporal artery and drained by bilateral superior ophthalmic, facial and superficial temporal veins No evidence of intracranial extension of the malformation Impression: The clinical image and the radiological findings are consistent with cirsoid aneurysm of the scalp
Discussion
Cirsoid means resembling a varix – referring to the characteristic variceal dilatation of the draining veins
They have been previously referred to as aneurysma serpentinum or aneurysma racemosum
Occurs due to abnormal vascular connections (arterio-venous shunts) within the scalp between the branches of external carotid artery and the scalp veins. It can either congenital or traumatic in origin
Most common feeder-Superficial temporal artery
Clinical presentation: Gradually progressive pulsatile scalp swelling. Progressive cosmetic deformity
Investigations: Gold standard- Invasive Angiography to delineate the lesion ,exclude an intracranial component and for therapeutic benefits CT and MR Angiogram - Non invasive ,hence often preferred ,and also useful to exclude differential diagnoses
Treatment: Surgical excision, endovascular occlusion, and direct percutaneous injection of sclerosing agents.
Differential diagnosis:
1.Calvarial vascular malformations, 2.Traumatic aneurysm of the superficial temporal artery 3.Scalp hemangiomas, and 4.Vascular malformations with both intra and extracranial components such as sinus pericranii.
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!