When a palmar mass is vascular: ulnar artery pseudoaneurysm of the hand. A case report

A 56-year-old right-handed man presented with a painful, progressively enlarging pulsatile mass in the palm associated with paresthesia in the ulnar nerve distribution, reproduced by a positive Tinel’s sign at Guyon’s canal, without objective motor deficit. Initial clinical suspicion included a soft tissue tumor. On physical examination, the lesion was tender and pulsatile. Doppler ultrasound and magnetic resonance angiography confirmed a saccular pseudoaneurysm of the ulnar artery. Surgical treatment consisted of pseudoaneurysm resection and direct microsurgical repair of the arterial defect under magnification. Complete excision and restoration of arterial continuity were achieved without intraoperative complications. The postoperative course was uneventful, with progressive resolution of neurological symptoms. At two months, the patient had returned to normal activities, with preserved hand function and confirmed arterial patency on ultrasound. Ulnar artery pseudoaneurysms are rare and may present as palmar masses, leading to diagnostic delay. A high index of suspicion and appropriate imaging are essential for accurate diagnosis. Type of Study / Level of Evidence: Case report; Level V evidence.