PSEUDOANEURYSM OF THE VERTEBRAL ARTERY PRESENT- ING AS A NECK SWELLING : REPORT OF A CASE A. THAKAR, Senior Resident S. BAHADUR, Additional Professor D.A. TANDON, Associate Professor. Department of Otorhinolaryngology and Head & Neck Surgery N.K. MISRA, Additional Professor, Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi 110 029, India A twelve year old boy presented with a firm swelling of three months duration in the left posterior cervical triangle. The swelling was 8 cm in diameter. C T revealed a widened left vertebral canal, erosion of the transverse processes of C 2 and subluxation between C, and C2 with fracture C2. A spontaneous severe haemorrhage from the swelling compelled an im- mediate surgical exploration. The extravertebral mass was excised and a dehiscence in the transverse processes was plugged with sternocleidomastoid muscle flap to stop the bleeding. The patient made an uneventful recovery. Sustained questioning of the patient revealed a history of a fall from a bicycle three months prior to the present episode. On re-evaluation of the CT pictures it was concluded that the lesion was a pseudoaneurysm of left vertebral ar- tery and should have been diagnosed as such on the initial CT. CASE REPORT A twelve year old male child was referred to our hospital with a progressive swelling in the left upper neck of three months duration. No history of trauma was volunteered even on direct questioning. It was associated with local pain and limitation of neck movement. Over a period of three weeks prior to admission it had rapidly increased in size with ulceration of the overlying skin and he had had two episodes of self-limiting bleeding from the ulcer. Examination revealed a cachexic child with torticollis and a well defined, tender swelling eight centimetres in diameter in the left upper neck. The overlying skin was ulcerated with granulation tissue on the base of the ulcer. The skin felt warm and the swelling itself was situated deep to the contracted sternocleido mastoid muscle. It was non-pulsatile, non- compressible, demonstrated no thrill of bruit and the distal carotid pulsations were normally palpable. There was no neurological deficit. Investigations revealed leukocytosis and a raised ESR. A lateral x-ray of the cervical spine demonstrated a subluxation between C, and C 2 . A contrast enhanced CT scan confirmed the same and showed a large ill-defined soft tissue mass in the left posterior triangle with central enhancement and erosion of the left transverse process of C 2 (figs 1 and 2). The CT findings were reported to be consistent with a malignant soft tissue tumour. Fine needle aspiration yielded only blood on two occasions and a biopsy from the granulation tissue was not contributory. Following a course of antibiotics the local pain and tenderness diminished. However on the third day following admission he had a severe bleed from the ulcerated area. It was therefore decided to surgically explore the neck immediately with the intent of controlling the bleeding and taking a biopsy. At surgery a thrombotic, friable mass was found deep to the sternocleidomastoid. The mass engulfed the carotid system. The carotid complex was adequately exposed above and IJO & HNSNOL.47, NO.4, Oct -Dec, 1995 G.7J