Pair each patient presentation with the most appropriate initial diagnostic test or immediate management step.
- A 72-year-old male former smoker presents with severe abdominal pain, a pulsatile periumbilical mass, and a systolic blood pressure of 80 mm Hg.Immediate transfer to the operating room for surgical repair
- A 55-year-old hypertensive female describes abrupt onset of excruciating interscapular pain and has unequal blood pressures in her upper extremities.Computed tomography angiography (CTA) of the aorta
- A 68-year-old male with diabetes reports cramping pain in his right calf that occurs consistently after walking three blocks and resolves with a few minutes of rest.Ankle-brachial index (ABI) measurement
- A 35-year-old female using oral contraceptives develops acute unilateral left lower extremity edema, erythema, and calf tenderness.Lower extremity venous duplex ultrasonography
Answer
Match the unstable pulsatile abdominal mass with immediate surgery, the tearing interscapular pain with CTA of the aorta, the exertion-induced calf pain with ABI measurement, and the acute unilateral leg swelling with venous duplex ultrasonography.
Each clinical vignette provides a textbook presentation of a major vascular pathology. Unstable patients with ruptured aneurysms require immediate surgical repair. Stable patients with aortic dissection need CTA to delineate the anatomy. Chronic peripheral arterial disease is diagnosed with ABI, while acute deep vein thrombosis is diagnosed with venous ultrasound.
Step-by-Step Solution
Key Concept
Recognition and initial management of classic vascular presentations.