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Kishi. Plast Aesthet Res 2020;7:3 I http://dx.doi.org/10.20517/2347-9264.2019.50 Page 5 of 7

Table 1. Patient characteristics of all reports of congenital true palmar aneurysms
Collagen
Published
Ref. year Age Sex Side Dominant Artery vascular Operation
disease
Okuda et al. [1] 1987 5 years F R Palmar arch 4 Resection
Rikukawa et al. [2] 1992 12 years M L Ulnar Resection: end to end
anastomosis
Martin et al. [3] 1982 18 years M R Left Ulnar Resection + vein graft,
superficial v
Itoh et al. [4] 1992 8 months M L Common Resection
digital
Offer et al. [5] 1999 1 year M L Ulnar Resection
Witt et al. [6] 2003 8 years M L Ulnar Resection + vein graft,
reverse saphenous vein
Deune et al. [7] 2005 4 years M L Ulnar + Resection + vein graft
Al-Omran et al. [8] 2007 18 months M L Ulnar + Kawasaki Resection
Parsa et al. [9] 2008 12 years M R Right Ulnar Resection + vein graft
Amjad et al. [10] 2010 2 years M L Ulnar Resection
Iyer et al. [11] 2012 5 months F L Ulnar Resection ligated
Stalder et al. [12] 2016 15 years M L Right Ulnar Resection + vein graft,
cephalic vein
Shutze et al. [13] 2017 16 years F L Common Resection
digital
Meals et al. [14] 2017 6 months M L Common Resection
digital
Dean et al. [15] 2019 13 months M R Common Resection
digital
Our case 2019 7 months M R Ulnar Resection + vein graft

TM
A palmar gypsum cast with Reston was kept in place for one year and his condition was satisfactory as of
this writing. There were no complications or abnormalities of blood flow or the median or ulnar nerve.

DISCUSSION
In Japan, 12 reports have been published on aneurysms in the palm, of which 10 were caused by trauma,
[1]
one had unknown etiology, and only one was diagnosed by Okuda et al. as a congenital aneurysm. In the
English literature, we found only 14 reports on aneurysms in the palm [2,3,15] , five of which were diagnosed
as congenital aneurysm but with underlying arteriosclerosis. Most aneurysms were caused by blunt
trauma, especially those located in the palm, and were thought to have arisen because the ulnar artery was
sandwiched between the hamate bone and skin. Such cases are considered to represent hypothenar hammer
[16]
syndrome. In 1772, Guattani was the first to describe a palmar aneurysm with most of the 52 reported
cases being caused by trauma and 30 involving the ulnar artery.

Doppler ultrasound can be used to detect the characteristic yin-yang sign of congenital aneurysm. MRI
is also effective for examining the luminal of the artery. MRA is however the most effective method for
examining vascular flow. According to the pathological findings, congenital aneurysms are characterized by
a poor inflammation and no arteriosclerosis. It is easy to distinguish them from congenital arteriovenous
fistula using arteriographic and MRA imaging findings. Furthermore, it is difficult to detect congenital
aneurysms in one-year-old children because identification of its symptoms is challenging in this
population, and the only physical finding is often a bump in the palm.

Among the 15 cases previously reported [1-15] , the site of occurrence was the ulnar artery in 10 cases, the
common digital artery in four cases, and the palmar arch in one case; the ulnar artery was involved in 67%
of cases [Table 1].