Final answer:
The presence of a pulsatile mass and bruising in the groin post-PCI suggests a pseudoaneurysm. The next step is to perform a duplex ultrasound to confirm the diagnosis, followed by appropriate treatment, which may include compression, thrombin injection, or surgical intervention.
Step-by-step explanation:
The question pertains to the management of a patient (pt) who has recently undergone percutaneous coronary intervention (PCI) and is now presenting with a pulsatile mass and bruising at the groin site. This clinical situation is highly suggestive of a pseudoaneurysm, which is a known complication post cardiac catheterization procedures, like PCI. A pseudoaneurysm occurs when there is a leak from the arterial puncture site that leads to blood collecting between the layers of the artery wall or surrounding tissue, forming a pulsating mass.
The next step in management should be an immediate assessment to confirm the diagnosis and determine the extent of the problem. This typically involves the use of ultrasonography, specifically a duplex ultrasound, to visualize blood flow and the structure of the mass. Once a pseudoaneurysm is confirmed, further treatment options may include ultrasound-guided compression, thrombin injection, or surgical intervention, depending on the size of the pseudoaneurysm and the condition of the patient.
It is critical to address this complication promptly to prevent rupture of the pseudoaneurysm, which can result in significant hemorrhage and other adverse outcomes. The patient should also be closely monitored for signs of infection, worsening pain, or changes in limb perfusion indicative of distal embolization. In some instances, if the pseudoaneurysm is small and stable, conservative management with observation may be considered. However, this approach should always be balanced with the potential risks of the pseudoaneurysm expanding or rupturing.