Description, Causes and Risk Factors:
Dilation of a group of blood vessels owing to congenital malformation with arteriovenous shunting.
It is now generally agreed that the cirsoid aneurysm is a form of arteriovenous fistula in which the earliest abnormal communications are between the arterioles and the venules. The inciting factor is believed to be trauma, frequently trivial, which results in rupture of the small vessels and brings about false communications between the smaller arteries and veins. The ultimate effect of such abnormal openings is to divert blood under arterial pressure directly into the venous system with resultant venous dilatation. The decreased resistance to the flow of blood from artery to vein at the site of the fistula as compared to the resistance to the flow of blood through the capillary bed elsewhere leads to an increase in the volume of blood flowing through the fistula and results in dilatation of all the vessels in the neighborhood. The cirsoid aneurysm comes to be composed essentially of two parts, the fistula itself and the dilated afferent and efferent vessels.
The cirsoid aneurysm is to be differentiated from an arteriovenous aneurysm and an angioma. The arteriovenous aneurysm affects the larger vessels and has but a single communicating fistula, pressure upon which causes the bruit or thrill to disappear. This phenomenon has been mentioned as Terrier's sign. In cirsoid aneurysms, the communications are multiple, are between the smaller vessels, and the bruit or thrill disappears only when pressure is exerted over the entire surface of the tumor. Congenital angiomas appear as simple red or bluish areas over which there is no thrill, bruit or pulsation.
A 52-year-old female presented with a one-year history of tinnitus and pulsatile swelling in the right preauricular region. A color Doppler ultrasound test and magnetic resonance angiography revealed a high-flow scalp arteriovenous fistula with a feeder vessel from the distal superficial temporal artery, which drained into the corresponding, dilated, tortuous vein. The patient underwent diagnostic digital subtraction angiography. This was followed by transarterial embolization of the fistula using a 50 per cent mixture of n-Butyl Cyanoacrylate glue and Lipiodol®, with manual distal venous occlusion. A successful outcome was achieved with instant relief of symptoms.
Clinical manifestation may include a loud continuous bruit, hemorrhage and throbbing headache, and in severe cases scalp necrosis.
Patient with bleeding is evaluated typically with a CT scan. Once bleeding is confirmed on a CT scan, definitive diagnosis of cirsoid aneurysm is made by angiography. MRI is also very helpful particularly with localizing cirsoid aneurysm. Once the location and appearance of the cirsoid aneurysm is decided, definitive plans for treatment are made.
The most effective means of treatment is by complete surgical removal. In spite of all precautions this operation carries some risk from severe hemorrhage. Cirsoid aneurysms are cured by excising or eliminating by ligation the abnormal communications between arteries and veins. It is not always possible to ascertain the exact site of such fistulae. In order to be certain that all of them have been extirpated, it is frequently necessary to remove large masses of dilated vessels. If an abnormal opening is overlooked, some of the dilated vessels will persist. This phenomenon has led some observers to regard cirsoid aneurysms as neoplastic in origin. However, the evidence, both histologic and from follow-up studies, suggests that they are not neoplastic.
NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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