Ulnar artery aneurysms, though uncommon, are encountered secondary to traumatic injury to the hand. The diagnosis can be unsuspected, especially in children, as symptoms may be subtle. A high index of suspicion and color flow Doppler technology enables accurate diagnosis. The following is a case of a child who suffered a traumatic ulnar artery aneurysm with an accompanying literature review and discussion highlighting reparative surgical interventions and the benefits of color flow Doppler in the management of ulnar artery aneurysms. Introduction True aneurysms of the ulnar artery, while uncommon1 are the most reported site of arterial aneurysms of the upper extremity2,3. Blunt trauma is the most common identifiable cause of true upper extremity arterial aneurysms. They are usually localized to the superficial segment of the ulnar artery on the hypothenar eminence and associated in adults with the hypothenar hammer syndrome, which results from repeated local injury4. In children, the lesion is rarer and can be more innocuous. The following is a case of a child who presented with an aneurysm of the ulnar artery due to blunt trauma. Ulnar artery aneurysms, diagnostic modalities, and management strategies are discussed. Case Presentation A right-hand dominant 13-year old male was referred for evaluation of a right hand mass. The hand was normal until 3 months prior to presentation when he fell while mountain biking. The hand was acutely painful with associated swelling, followed by evolution of a palpable mass within 24 hours after injury. Though swelling subsided, the mass persisted. At presentation, he denied numbness or weakness in the hand. There was a palpable pulsating mass in the ulnar/volar palm at the level of Guyon's canal. (Figure 1) An Allen test was consistent with a patent palmar arch with noted delayed ulnar antegrade fill. Ulnar neurosensorimotor examination was intact. Median nerve function was also normal. There was no thrill or bruit. Preoperative evaluation included color flow Doppler (CFD) studies, which revealed a dilated segment of the ulnar artery beyond the distal wrist crease. Both antegrade and retrograde flow was demonstrated, and signals were dampened supporting the diagnosis of an ulnar artery aneurysm.
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