Traumatic Vascular Injury to the Hand
A 10-year-old boy presented to the emergency department with a painful and growing lesion on the palm of his left hand. Three days earlier, his hand had been lacerated by a kitchen knife. The wound had been sutured in the emergency department after the initial injury. At the time of this presentation, a wound abscess was initially suspected, and povidone–iodine was applied to the hand in anticipation of incision and drainage. Examination of the hand before the procedure showed neurovascularly intact digits and a large, pulsatile mass without warmth or erythema (Panel A). A bruit was heard on auscultation of the lesion. Such vascular anomalies can result from congenital, postinfectious, or traumatic causes. There is a risk of substantial bleeding if they are inappropriately incised. The aneurysm was isolated and excised (Panel B), and the patient recovered without complications.