PULSATILE SWELLING
PULSATILE SWELLING: Excerpt from Algorithmic Diagnosis of Symptoms and Signs
A pulsatile swelling anywhere is an aneurysm until proven otherwise. However, frequently there is simply a benign or malignant tumor over a large artery that gives the false impression that the mass is an aneurysm when it is not. In the abdomen, a normal abdominal aorta may be mistaken for an aortic aneurysm, especially in thin patients. In the neck, normal carotid, brachial, or innominate arteries may pulsate vigorously when there is aortic regurgitation. Eggshell cracking along with the pulsation in a mass should suggest an osteosarcoma. A pulsating mass in the right upper quadrant is most likely the enlarged liver due to tricuspid regurgitation or stenosis. The presence of dependent edema and ascites will support the diagnosis. A pulsating tumor of the orbit is most likely a carotid cavernous fistula.
DIAGNOSTIC WORKUP
In cases of suspected abdominal aortic aneurysms, abdominal ultrasound will help differentiate the normal aorta or a tumor from a true aneurysm. When in doubt, CT scan or aortography should be done. It will be necessary before surgery anyway.
All other cases of pulsatile masses suggesting an aneurysm should receive angiography of the artery or arteries supplying the area.
Book Source Details
- Book Title: Algorithmic Diagnosis of Symptoms and Signs
- Author(s): R. Douglas Collins
- Year of Publication: 2003
- Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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