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A physician is called to see a 69-year-old woman who underwent cardiac catheterization via the right femoral artery earlier in the morning. She is now complaining of a cool right foot. Upon examination she has a pulsatile mass over her right groin with loss of her distal pulses, and auscultation reveals a bruit over the point at which the right femoral artery was entered. Which of the following is the most likely diagnosis?
A. Cholesterol emboli syndrome
B. Femoral aneurysm
C. Femoral hernia
D. Femoral pseudoaneurysm
E. Retroperitoneal hematoma
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D. femoral pseudoanurysm due to femoral catheterization
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Why not A? Can you please explain the answer?
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The correct answer is
D. Femoral pseudoaneurysms represent an important vascular complication of cardiac catheterization. The combination of a pulsatile mass, femoral bruit, and compromised distal pulses make this diagnosis likely. The diagnosis can be confirmed by ultrasound of the groin.
Cholesterol emboli syndrome (choice A) is also an important complication to recognize in the post-catheterization patient. It usually presents, however, with skin findings in the distal extremities of livedo reticularis, ischemic ulcerations, cyanosis, gangrene, or subcutaneous nodules.
Femoral aneurysms (choice B), like the more common aortic and popliteal aneurysms, are true aneurysms that represent a dilation of the arterial wall itself, often associated with an underlying connective tissue disorder or atherosclerotic disease. While true aneurysms may also present as pulsatile masses in the groin and may be associated with distal embolization of clots, the proximity to cardiac catheterization makes pseudoaneurysm likelier.
Femoral hernias (choice C) occur when abdominal contents pass through the femoral canal, with the hernia sac lying below Poupart's ligament. While it may present as a mass in the groin, a femoral hernia would unlikely be associated with a bruit or arterial vascular compromise.
Another important complication of cardiac catheterization via the femoral artery is a retroperitoneal bleed (choice E). This complication presents, however, as either new back pain, an unexplained drop in the hematocrit, or purpura over the flanks.
