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Contains a true endothelial lining resulting in a uniform dilatation of the artery
28%
126/449
Extravasated hematoma organizes and recanalizes to form a true aneurysm
6%
26/449
Penetration of the arterial wall causes recanalization without a true endothelial lining
10%
45/449
Recanalization of the lumen occurs after the blunt injury creating a false aneurysm
37%
164/449
True endothelial lining is replaced by a false lumen after repeated blunt trauma
19%
84/449
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The patient has hypothenar hammer syndrome with an ulnar artery aneurysm at the level of Guyon's canal secondary to blunt trauma, as evidenced by his hook of hamate fracture. Blunt trauma results in a true aneurysm with uniform arterial dilatation and a true endothelial lining (Answer 1). Hypothenar hammer syndrome represents post-traumatic digital ischemia from aneurysmal changes of the ulnar artery at Guyon's canal. Patients often present with pain over the hypothenar eminence and ring finger, with paresthesia along the ulnar-most two digits, cold intolerance, and mottling and blanching indicative of ischemia. Blunt trauma results in the formation of a "true" aneurysm that contains all arterial layers, specifically a true endothelial lining, that allows the vessel to gradually dilate and form a more uniform shape. A pseudoaneurysm, by contrast, results from arterial wall penetration, in which extravasated hematoma subsequently organizes and then recanalizes, forming a "false" lumen with no endothelial lining. Bernik et al. published a case report of a patient with an ulnar artery aneurysm and hypothenar hammer syndrome (HHS). The authors note that repetitive striking of the palmar portion of the ulnar artery has been known to cause HHS, with symptoms of HHS including ischemia and pain in the digits. They concluded that despite its rarity, physicians should consider HHS as a potential cause of ischemia and pain in the hand and fingers, with methods of intervention including resection and anastomosis. Ho et al. reviewed aneurysms of the upper extremity. The authors reviewed thirty aneurysms in the upper extremities of 28 patients over 10 years and found that false aneurysms develop from penetrating trauma, while true aneurysms tend to arise in parts of the arterial tree exposed to blunt trauma. They concluded that when an aneurysm is suspected, early treatment is advised, with treatment options including resection and ligation versus reconstitution of vessel flow being based on preoperative and intraoperative evaluation of circulatory status.Figure A is a carpal tunnel view radiograph demonstrating a hook of hamate fracture. Figure B is an angiogram showing an ulnar artery aneurysm at the level of Guyon's canal.Incorrect Answers: Answers 2-3: A penetrating injury results in recanalization of the arterial lumen to form a false, not true, aneurysm without a true endothelial lining, Answers 4-5: Recanalization of the lumen to form a false, or pseudoaneurysm, occurs after a penetrating injury, not after blunt trauma.
1.0
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