A 73-year-old man comes to the physician because of right anterior thigh pain that is worse with walking. He has a history of stable angina, hypertension, hypercholesterolemia, and COPD with periodic exacerbations. He takes ipratropium, aspirin, metoprolol and pravastatin. He smokes 2 packs a day and drinks alcohol occasionally. Physical examination shows a small pulsatile mass in the right groin area. Which of the following is the most likely diagnosis?

Question

A 73-year-old man comes to the physician because of right anterior thigh pain that is worse with walking.  He has a history of stable angina, hypertension, hypercholesterolemia, and COPD with periodic exacerbations.  He takes ipratropium, aspirin, metoprolol and pravastatin.  He smokes 2 packs a day and drinks alcohol occasionally.  Physical examination shows a small pulsatile mass in the right groin area.  Which of the following is the most likely diagnosis?

Quizplus · Accepted Answer

The clinical scenario described is consistent with a femoral artery aneurysm. A pulsatile groin mass below the inguinal ligament is characteristic; anterior thigh pain is due to the compression of the femoral nerve that runs lateral to the artery. Femoral artery aneurysm is the second most common peripheral artery aneurysm after popliteal aneurysm. It may be associated with an abdominal aortic aneurysm. (Choice E) Femoral hernias are located below the inguinal ligament, but are not pulsatile. (Choices C and D) Inguinal hernias are located above the inguinal ligament; an indirect hernia may descend into the scrotum. (Choice A) Femoral vein dilatation usually results from AV fistula (typically traumatic); venous hypertension usually results. Educational Objective: Peripheral artery aneurysm manifests as a pulsatile mass that can compress adjacent structures (nerves, veins), and can result in thrombosis and ischemia. Popliteal and femoral artery aneurysms are the most common peripheral artery aneurysms. They are frequently associated with abdominal aortic aneurysms.

A 73-Year-Old Man Comes to the Physician Because of Right