Is a blueberry‑size lump in the groin normal seven days after a femoral cardiac catheterization?

A Blueberry-Sized Lump 7 Days Post-Femoral Cardiac Catheterization Requires Immediate Ultrasound Evaluation

A blueberry-sized lump (approximately 1-2 cm) in the groin 7 days after femoral cardiac catheterization is NOT normal and requires urgent duplex ultrasound evaluation to rule out pseudoaneurysm, as physical examination alone misses more than 60% of these complications. 1

Why This Requires Immediate Attention

The timing and size of this lump raise significant concern for a pseudoaneurysm, which occurs in 0.1-0.2% of diagnostic procedures and 3.5-5.5% of interventional procedures. 2, 1 While physical examination is notoriously unreliable for detecting pseudoaneurysms, any suspected mass at the catheterization site mandates duplex ultrasound imaging. 2, 1

Critical Assessment Steps You Must Perform Now

Palpate for a pulsatile mass - this is the most important physical finding, though its absence does not exclude pseudoaneurysm. 1

Check bilateral pedal pulses and compare Doppler systolic blood pressures between legs - a pressure less than two-thirds of the contralateral leg indicates significant arterial compromise requiring immediate intervention. 1, 3

Assess for these warning signs:

• Expanding swelling or hematoma 3
• New pain, numbness, or weakness in the leg 1
• Color changes in the extremity 1
• Coolness of the affected limb 4

Understanding Pseudoaneurysm Risk at This Size

The evidence provides clear guidance on size thresholds:

Pseudoaneurysms <2.0 cm can potentially be managed conservatively with ultrasound follow-up, as 61% resolve spontaneously within 7-52 days, and 90% that will close do so within 2 months. 2, 1

Pseudoaneurysms ≥2.0 cm that persist or recur require active treatment with ultrasound-guided compression or thrombin injection. 2, 1

A "blueberry-sized" lump (approximately 1-2 cm) sits at this critical threshold, making imaging essential to determine exact size and whether it represents a pseudoaneurysm, simple hematoma, or other complication.

The Diagnostic Algorithm You Should Follow

1. Obtain duplex ultrasound immediately - do not wait for symptoms to worsen, as this is the only reliable way to diagnose pseudoaneurysm. 2, 1

2. If ultrasound confirms pseudoaneurysm <2.0 cm and patient is asymptomatic:

   • Conservative management is reasonable 2, 1
   • Schedule repeat ultrasound in 1 month 2
   • Provide strict return precautions for new swelling, pulsatile mass, pain, numbness, weakness, or color changes 1

3. If ultrasound confirms pseudoaneurysm ≥2.0 cm:

   • Proceed with ultrasound-guided thrombin injection or compression therapy 2, 1
   • Note that larger longitudinal diameter (>1.8 cm) and neck diameter (>0.55 cm) predict higher failure rates requiring multiple treatment sessions 5

4. If no pseudoaneurysm but simple hematoma:

   • Reassure patient but maintain vigilance
   • Provide return precautions 1

Common Pitfalls to Avoid

Do not rely on physical examination alone - more than 60% of pseudoaneurysms are missed clinically, making ultrasound mandatory when any mass is palpable. 2, 1

Do not assume "it's just a bruise" - while hematomas are common, a discrete lump persisting at 7 days requires definitive imaging to exclude pseudoaneurysm. 1

Do not delay imaging in high-risk patients - factors including female sex, age ≥70 years, anticoagulation, glycoprotein IIb/IIIa inhibitor use, and interventional (vs diagnostic) procedures all increase pseudoaneurysm risk. 1

What Makes This Case Concerning

The 7-day timeframe is significant because while most simple hematomas improve by this point, pseudoaneurysms can present days to weeks after the procedure and will not resolve without intervention if ≥2.0 cm. 2, 1 The persistence of a palpable lump at one week, rather than gradual resolution, shifts the probability toward pseudoaneurysm rather than simple bruising.