Registered Cardiovascular Invasive Specialist (RCIS) Practice Test

What should be suspected if a patient presents with a pulsatile mass below the sheath site and a bruit is present?

1. Aortic dissection

2. Pseudaneurysm

3. Abdominal aortic aneurysm

4. Cardiac tamponade

The correct answer is: Pseudaneurysm

A pulsatile mass located beneath the sheath site, accompanied by a bruit, is indicative of a pseudaneurysm. This condition occurs when there is a disruption in the vascular wall, leading to a contained rupture; blood escapes from the artery but remains within the surrounding tissue, forming a sac-like structure. The presence of a pulsatile mass suggests that blood is flowing into this sac, while the bruit indicates turbulent blood flow—a characteristic feature of the abnormal communication between the artery and the surrounding tissue. Pseudaneurysms are most commonly associated with procedures involving vascular access, such as catheterization, where the risk of arterial injury during puncture can lead to this complication. Their identification is crucial because timely intervention can prevent further complications such as complete rupture or vascular insufficiency. The other conditions present different clinical scenarios. For instance, an aortic dissection refers to a tear in the aorta's inner layer, leading to a different symptomatology and usually not presenting as a pulsatile mass below a sheath site. An abdominal aortic aneurysm, similarly, typically presents as a more central mass in the abdomen rather than localized below a sheath. Cardiac tamponade, on the other hand, involves fluid accumulation around the heart, leading to he