PULSATILE MASS

Simply by thinking of the location of the pulsatile mass, one can identify the cause or causes of a pulsatile mass. Orbit. This is most likely an arteriovenous fistula related to trauma or the spontaneous rupture of an aneurysm into the cavernous sinus. Neck. A carotid, innominate, or brachial artery aneurysm is the most likely cause here, but pulsations may be felt in the neck from aortic regurgitation as well. Chest. An aneurysm of the thoracic aorta is the most likely cause here, but an enlarged heart or cardiac aneurysm may give a noticeable heave on inspection. Abdomen. Tricuspid regurgitation may cause pulsations of the liver in the right upper quadrant, but the associated ascites and dependent edema should make the diagnosis obvious. A pulsating abdominal aorta is usually an atherosclerotic aneurysm, but it may be an abnormal finding in asthenic individuals. It is also possible that the pulsating mass is a tumor over a normal abdominal aorta. Extremities. A pulsating mass in the axilla, groin, or popliteal fossa is usually an aneurysm, but osteosarcoma can produce a pulsating mass along with eggshell cracking.

Approach to the Diagnosis

Ultrasonography will usually confirm the diagnosis of these lesions, but a CT scan or angiography may be necessary, particularly when surgical intervention is planned. A cardiovascular surgeon should be consulted before ordering these expensive tests.

Book Source Details

• Book Title: Differential Diagnosis in Primary Care
• Author(s): R. Douglas Collins MD, FACP
• Year of Publication: 2007
• Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.

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