Spontaneous resolution of traumatic pseudoaneurysm: A case report

Abstract

Rationale: – A traumatic pseudoaneurysm (TP) is a rare vascular pathology. Once diagnosed, active surgical intervention is usually required. However, in addition to growth and rupture, the natural outcomes of TPs also include spontaneous resolution. This article reports a rare case of a TP that resolved spontaneously, with the aim of informing future clinical strategies. Patient concerns: – A 47-year-old female patient underwent decompressive craniectomy with hematoma evacuation following head trauma. Initial computed tomography angiography demonstrated a pointed protrusion along the ophthalmic segment of the left internal carotid artery. Two weeks post-injury, follow-up computed tomography angiography revealed a saccular protrusion at the same site, measuring 6.0 mm × 3.7 mm with a neck width of 6.3 mm. Digital subtraction angiography (DSA) at 3 weeks post-injury confirmed a saccular aneurysm in the ophthalmic segment of the left internal carotid artery. Diagnoses: – The combination of a history of trauma and a rapidly growing lesion was highly suggestive of a TP. Interventions: – Four weeks post-injury, follow-up DSA demonstrated a progressive reduction in the aneurysm size, prompting the family to opt for conservative management. Outcomes: – Eight weeks post-injury, DSA confirmed the spontaneous disappearance of the aneurysm. A 1-month post-discharge telephone follow-up revealed no symptoms of clinical recurrence, such as headache or epistaxis. Lessons: – Since spontaneous healing of TP is uncommon and its mechanism remains unclear, conservative management mandates close imaging surveillance, as a risk of recurrence persists even with the most prudent patient selection.