Multidetector computed tomography in the evaluation of cirsoid aneurysm of the scalp—a manifestation of trauma Charbel Saade a,b, ⁎ , Mark Wilkinson a , Geoff Parker a , Steve Dubenec a , Patrick Brennan b a Royal Prince Alfred Hospital, Radiology Department, Missenden Rd, Camperdown, 2050, Sydney Australia b Discipline of Medical Radiation Sciences, C42 - Cumberland Campus, The University of Sydney, Lidcombe, NSW 2141 Australia Received 17 June 2012; accepted 2 July 2012 Abstract Cirsoid aneurysms of the scalp are a rare abnormality with severe cosmetic deformity and possibly of severe hemorrhage. They present as a diagnostic and management challenge, but evaluation with multidetector computed tomography is useful in the diagnosis and treatment planning of these clinically complex disorders of the extracranial circulation. We present a case report of a 38-year-old New Caledonian male who had a large pulsatile mass in his scalp, which had progressively increased in size since the age of 17 years. The clinical and imaging features are outlined, in addition to treatment and prognosis. Crown Copyright © 2013 Published by Elsevier Inc. All rights reserved. Keywords: Cirsoid aneurysm; MDCT; Contrast; Arteriovenous fistulae 1. Introduction Cirsoid aneurysms of the scalp are rare arteriovenous fistulae (AVF) of the scalp [1] that can be either congenital or traumatic [2]. These are very challenging to treat largely due to the complex angioarchitecture. Whilst conventional angiography is the gold standard, multidetector computed tomography (MDCT) is rapidly becoming the preferred method of imaging in the acute setting. Treatment options include surgical resection, endovascular occlusion, direct percutaneous injection of sclerosing agents [3], or a combination of these methods. 2. Case Report This 38-year-old New Caledonian man was referred for management of a traumatic arteriovenous fistulae of his scalp, resulting from a direct blow over the midline scalp, with a stool, as a 17-year-old. He first noted enlargement of his scalp vessels and pulsatile mass formation in the midline 12 months later but did not seek treatment due to his remote geographical domicile and limited healthcare facilities. By the age of 38, there was a 9.5×9-cm soft, compressible, pulsatile swelling of the scalp with prominent dilated and tortuous vessels in the malformation and enlarged palpable superficial temporal arteries. There were no overlying cutaneous changes apart from residual skin. The patient was in good health otherwise. MDCT of the head, conventional angiography and three- dimensional reconstruction demonstrated significant dilata- tion of the superficial temporal, supratrochlear and supraor- bital arteries bilaterally, and the right occipital artery, and a large midline nidus (Fig. 1). 2.1. Intra- and extra-cranial MDCT angiogram MDCT angiography was performed using a 64-MDCT scanner (VCT Lightspeed; GE Healthcare; Milwaukee, WI, USA) with a scan range from the apex of the cranial vault to the aortic arch. Contrast material was simultaneously injected (Optivantage; Covidien, Cincinnati, OH, USA) using the optibolus technique via a 20-gauge venous catheter in the right arm [4,5]. Bolus geometry was measured using Clinical Imaging 37 (2013) 558 – 560 ⁎ Corresponding author. Royal Prince Alfred Hospital, Radiology Department, Missenden Rd, Camperdown, 2050, Sydney Australia. Tel.: +61 415193777; fax: +61 295158240. E-mail addresses: info@mdct.com.au (C. Saade), mcwilkinson@internode.on.net (M. Wilkinson), geoffp22@me.com (G. Parker), sdubenec@optusnet.com.au (S. Dubenec), Patrick.brennan@sydney.edu.au (P. Brennan). 0899-7071/$ – see front matter. Crown Copyright © 2013 Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.clinimag.2012.07.001