Pulsatile mass on the collarbone

Introduction The pulsatile mass on the clavicle is a clinical manifestation of a peripheral aneurysm. Peripheral aneurysms are aneurysms that occur in the main arteries such as the carotid artery and the extremity arteries. The aneurysm is typically characterized by a pulsatile mass with a smooth surface, which can be accompanied by tremors and murmurs. The proximal artery of the lesion is compressed, which can reduce the mass, reduce the tension, and reduce the tremor and noise. Aneurysms can compress peripheral nerves, veins, and organs due to their mass effect, and produce corresponding symptoms. The symptoms vary with the location of the aneurysm and the structure of the compression. Compression of the nerve can cause sensation, movement disorders, compression of the vein can lead to reflux disorders, resulting in limb swelling.

Cause

Etiology: generally divided into two types: true aneurysm and pseudoaneurysm: the former is usually caused by atherosclerosis, and the tumor wall contains a three-layer structure of the arterial wall, which may be multiple or concurrent with aortic aneurysm; Often secondary to arterial trauma (such as knife stab wounds, arterial puncture), the tumor wall is fibrous tissue, mostly single. Various infectious factors (such as infectious emboli that fall off during bacterial endocarditis) can also destroy the arterial wall and form a so-called infectious aneurysm.

an examination

Related inspection

Chest flat chest test

1. General inspection

For patients with suspected infectious or inflammatory aneurysms, blood tests such as blood routine, blood culture, erythrocyte sedimentation rate, CRP, etc. may help with diagnosis. For elderly patients, the vital functions of the heart, lung, liver, brain and kidney should be comprehensively evaluated.

2. Image inspection

(1) Color Doppler ultrasound: For the non-invasive examination method, the aneurysm and other adjacent tumors can be distinguished, and the size and location of the aneurysm can be initially understood.

(2) CTA or MRA: For the preferred method of clinical diagnosis, CTA is more commonly used to determine the location, size, intracavitary wall thrombus and adjacent organ involvement of the aneurysm.

(3) Digital subtraction angiography: The standard method for vascular examination can show the size, location and collateral circulation of the aneurysm; however, it is impossible to distinguish the wall thrombus, which may underestimate the size of the aneurysm.

Differential diagnosis

Depending on the location of the surrounding aneurysm, each may have its own special symptoms and signs:

1 carotid aneurysm: There is a pulsatile mass on the lateral side of the neck. It can cause hoarseness, cervical sympathetic nerve and brachial plexus nerve, and there are symptoms such as hoarseness, Horner's syndrome, upper limb weakness, and paresthesia. When the aneurysm ruptures, it can cause hemorrhage or even suffocation. When the thrombus in the tumor cavity falls off, it can cause intracranial artery embolism and ischemic stroke.

2 subclavian aneurysm: pulsatile mass can be found in the supraclavicular region, brachial plexus compression causes upper limb paresthesia and dyskinesia, tumor thrombosis can cause acute upper limb ischemia or cerebral ischemia.

3 aneurysms: The pulsatile mass is located inside the thigh. When the tumor compresses the femoral nerve, there is numbness and radiation pain in the lower extremities; swelling of the lower extremities occurs when the femoral vein is compressed; the thrombus detachment in the tumor cavity can cause acute lower extremity arterial embolism, pain in the affected limb, paleness, and decreased skin temperature.

4 aneurysm: visible atrial pulsatile mass. Due to thrombus occlusion in the tumor cavity, thrombosis, embolization of the distal artery or tumor rupture of blood pressure, often cause severe ischemia of the calf, leading to lameness, rest pain and even necrosis.

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