A 55-year-old man comes to the office due to chronic pain in his buttock, hip, and thigh muscles. The aching pain is present in both legs and usually is associated with walking. He has multiple medical problems and takes several medications. He has a 30-pack-year smoking history. His temperature is 36.7 C (98 F), blood pressure is 150/88 mm Hg, pulse is 80/min, and respirations are 16/min. Examination shows decreased femoral, popliteal, and dorsalis pedis pulses in both legs. Which of the following additional complaints is most likely in this patient?

Question

A 55-year-old man comes to the office due to chronic pain in his buttock, hip, and thigh muscles.  The aching pain is present in both legs and usually is associated with walking.  He has multiple medical problems and takes several medications.  He has a 30-pack-year smoking history.  His temperature is 36.7 C (98 F), blood pressure is 150/88 mm Hg, pulse is 80/min, and respirations are 16/min.  Examination shows decreased femoral, popliteal, and dorsalis pedis pulses in both legs.  Which of the following additional complaints is most likely in this patient?

Quizplus · Accepted Answer

Explanation: This patient has arterial occlusion at the bifurcation of the aorta into the common iliac arteries (aortoiliac occlusion), with findings suggestive of Leriche syndrome, which is characterized by the triad of: Bilateral hip, thigh, and buttock claudication Absent or diminished femoral pulses: from the groin distally, often with symmetric atrophy of the bilateral lower extremities due to chronic ischemia Impotence: almost always present in men with this condition; in the absence of impotence, an alternate diagnosis should be sought Men with a predisposition for atherosclerosis, such as smokers, are at the greatest risk of this condition. Because impotence is not uncommon in this age group and hip and thigh pain with walking may also be attributed to osteoarthritis, the diagnosis of aortoiliac occlusion can be missed if a thorough vascular examination is not performed. (Choice A) Snoring may be primary (ie, not associated with underlying pathology) or may be a symptom of obstructive sleep apnea. (Choice B) Temporal arteritis is associated with new-onset headache, temporal tenderness and pulselessness, older age, and an increased ESR. Jaw claudication and amaurosis fugax may also occur. (Choice C) Anorexia may be a sign of an underlying malignancy, mesenteric ischemia, or bowel disorder. (Choice D) Ankle swelling may result from venous insufficiency, renal insufficiency, right heart failure, or hepatic disease; however, it is not a common finding in arterial occlusive disease. (Choice F) Neck pain is typically associated with cervical pathology rather than aortoiliac occlusion. Educational objective: Aortoiliac occlusion (Leriche syndrome) is characterized by the triad of bilateral hip, thigh, and buttock claudication; impotence; and absent or diminished femoral pulses (often with symmetric atrophy of the bilateral lower extremities due to chronic ischemia).

A 55-Year-Old Man Comes to the Office Due to Chronic