Pulsating mass

Introduction Pulsatile masses are more likely to be vascular lesions or closely related to blood vessels. Imaging studies such as angiography and blood flow ultrasound can clearly identify the location, quantitative and qualitative diagnosis, and can understand the blood supply and the relationship with the surrounding large blood vessels. 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. After the occurrence of peripheral aneurysms, it will develop progressively. The disease should be treated promptly to prevent the deterioration of the disease, mainly surgical treatment.

Cause

The etiology and classification are 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; The latter is often secondary to arterial trauma (such as 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

Hemorheological examination angiography abdominal shape palpation head and face palpation

Patients with high aortic hemangioma may have pulsation at the sternocleidal joint or a palpable pulsatile mass in the sternal fossa. When the aneurysm gradually enlarges to the anterior chest wall and erodes the sternum, it can cause severe pain. In severe cases, the tumor can pass through the chest wall and appear as a pulsatile mass. A descending aortic aneurysm can erode the thoracic transverse process or ribs, even on the back of the body.

Clinical manifestations: The most important clinical manifestation is a local pulsatile mass consistent with heart beats, accompanied by pain, tremors and vascular murmurs.

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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