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Case 290.

Hualin Yan1, Chenyun Zhou1, Feng Yan1

  • 1From the Departments of Medical Ultrasound (H.Y., C.Z., X.W., Y.L.) and Medical Ultrasound, Laboratory of Ultrasound Imaging Drug (F.Y.), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China.

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A 26-year-old man experienced chest pain and a leg mass, initially diagnosed with pulmonary embolism (PE). Further imaging revealed an unusual inguinal mass, prompting a deeper investigation into the cause of his symptoms.

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Area of Science:

  • Vascular Medicine
  • Diagnostic Imaging
  • Radiology

Background:

  • A young male presented with chest pain and a right inguinal mass with leg edema.
  • Initial diagnosis of pulmonary embolism (PE) was made after CT angiography (CTA) revealed a pulmonary artery clot.

Purpose of the Study:

  • To investigate the etiology of a palpable inguinal mass and lower extremity edema in a patient with a history of pulmonary embolism.

Main Methods:

  • Conventional and contrast-enhanced ultrasound (US) of the right lower extremity.
  • CT angiography (CTA) of the pulmonary arteries.
  • Contrast-enhanced CT of the lower abdomen.

Main Results:

  • Pulmonary CT angiography (CTA) identified a segmental pulmonary embolus in the left lower lobe.
  • Physical examination revealed a 4 × 3 cm palpable right inguinal mass.
  • Laboratory work-up showed normal D-dimer but prolonged prothrombin time and activated partial thromboplastin time.

Conclusions:

  • The case highlights the importance of comprehensive imaging and evaluation for unexplained masses in patients with thromboembolic events.
  • Further investigation is warranted to determine the nature of the inguinal mass and its relationship to the patient's presentation.