Question of the Week # 230

230) A 72-year-old white man with history of type 2 diabetes mellitus and hypertension is evaluated in your office during a follow up visit. He was discharged 3 days ago from the hospital after undergoing diagnostic cardiac catheterization for an abnormal exercise stress test. Femoral sheath was removed three days ago. He denies any chest pain or shortness of breath.  On physical examination, he is afebrile, HR 120/min and blood pressure is 120/70 mm hg.  There is a new palpable mass in the right groin and systolic bruit is heard at the catheter insertion site. Dorsalis pedis and posterior tibial pulses are intact. Which of the following is the most likely diagnosis?

A)     Arterio-venos fistula

B)     Local Hematoma

C)      Femoral artery true aneurysm

D)     Hematoma in continuity with arterial lumen

E)     Femoral artery thrombosis

9 Responses

  1. a

  2. Either a or d but most likely a.

  3. 230- answer is D

  4. A

  5. Differentiating a Psuedoaneurysm from an AV Fistula

    Psuedoaneurysm Arteriovenous Fistula

    Pulsatile mass No pulsatile mass
    Systolic bruit Systolic and diastolic bruit
    No thrill palpated Thrill present
    [Figure 3 ILLUSTRATION OMITTED]

    therefore answer is hematoma inc ontinuity with lemen(pseudoaneurysm)

  6. B….

    Differentiating a Psuedoaneurysm from an AV Fistula

    Psuedoaneurysm Arteriovenous Fistula

    Pulsatile mass No pulsatile mass
    Systolic bruit Systolic and diastolic bruit
    No thrill palpated Thrill present

    Certain factors may contribute to the development of a pseudoaneurysm. These include both predisposing patient factors and operator factors. Predisposing patient factors include vigorous anticoagulation, age greater than 70, female gender, low nadir platelet count, hypertension, atherosclerosis, and aortic insufficiency. Some operator factors may include multiple catheter exchanges, poor hemostasis during the procedure or after catheter removal, or a puncture placed too low (below the common femoral artery, in the superficial or profunda femoral artery)

    http://findarticles.com/p/articles/mi_m0FSS/is_n2_v6/ai_n18607334/

  7. D) Hematoma in continuity with arterial lumen (Pseudoaneurysm)

    Also…A-V fistula should have wide pulse pressure

    but how do you explain tachycardia?

  8. D

  9. Distinctively, in a pseudoaneurysm, the hole in the arterial wall is generally the consequence of an iatrogenic trauma, most likely a previous invasive medical procedure

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