Groin Pain & Syncope

UnFiNiShEd CaSe CoMe BaCk LaTeR

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History of Present Illness:

A man in his 60s presents to the ED for one day of left groin pain that started in the morning and became severe after dinner with a syncopal episode

Vital Signs & Physical Exam:

Vital signs are normal except for pulse of 48 and BP of 88/62.   Physical exam is otherwise normal except for diminished left leg pulse.

Initial Diagnostic Testing:

• EKG: none
• Labs: none ordered
• Imaging: a CT scan is done

QUESTIONS:

1. What does the case image show?  
2. What should you do next?  
3. Want a 1-minute consult/tutorial on this case? 
4. Want to know what happened with this patient?

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ANSWERS:

1. What does the case image show?  The image shows a ruptured 7.5cm iliac artery aneurysm on the left.
2. What should you do next?  Aim to keep BP on the low side to prevent further bleeding.  Call vascular for emergent intervention
3. Want a 1-minute consult/tutorial on this case?  See yellow area from sample page below.
4. Want to know what happened with this patient?  See case conclusion below tutorial page.

1-Minute EM Consult on the topic for this case from the Emergency Medicine 1-minute Consult Pocketbook

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CASE CONCLUSION: Iliac artery aneurysm 7.5 cm with rupture and retroperitoneal hematoma