Pseudoaneurysm?, True anuerysm?, Fistula?, or Thrombosis? - USMLE Forums
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  #1  
Old 03-05-2013
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Default Pseudoaneurysm?, True anuerysm?, Fistula?, or Thrombosis?

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
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Old 03-05-2013
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Default

Quote:
Originally Posted by stfidel View Post
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
D) Hematoma in continuity with arterial lumen
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Old 03-05-2013
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Default B) Local Hematoma

B) Local Hematoma
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Old 03-05-2013
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Default Pseudoaneurysm

Quote:
Originally Posted by fadi551 View Post
B) Local Hematoma
Not local hematoma cos of presence of bruit.

After catherization

palpable mass + no overlying bruit= hematoma

palpable mass + overlying bruit without hyperdynamic circulation= pseudoaneurysm

palpable mass + overlying bruit with hyperdynamic circulation = AV fistula

palpable mass +/- bruit with no distal pulse= femoral artery thrombosis
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