Question

A patient presents with a tender pulsatile mass, as shown in the image below. What will be done next for this patient?

• A. Ultrasound doppler
• B. Needle aspiration
• C. CT angiogram with percutaneous management
• D. Intravenous antibiotics for 7 day

Answer 1

The Correct Option is A

To determine the appropriate management for a patient presenting with a tender pulsatile mass, it is essential to first confirm the diagnosis and evaluate the characteristics of the mass. The best initial diagnostic tool in this context is an Ultrasound Doppler. This non-invasive imaging technique allows clinicians to assess blood flow, identify vascular abnormalities, and differentiate between different types of mass based on their vascularity.

Here's why each option is considered:

1. Ultrasound Doppler: This is the correct choice because it provides real-time images of blood flow and the structure of blood vessels, helping in the diagnosis of vascular conditions such as pseudoaneurysms, hematomas, or vascular tumors.
2. Needle aspiration: This technique is invasive and carries risks, especially in a vascular mass. It is not suitable as the initial step without first confirming the nature of the mass.
3. CT angiogram with percutaneous management: This is a more advanced diagnostic and therapeutic approach that is usually considered after initial imaging confirms a vascular lesion, especially if invasive management is needed.
4. Intravenous antibiotics for 7 days: This treatment is appropriate for infections; however, without confirming an infectious etiology through imaging, prescribing antibiotics is premature.

Conclusion: An Ultrasound Doppler is the appropriate next step for evaluating the tender pulsatile mass to determine its nature and guide further management.