Pulsatile Epigastric Mass in a 31-Year-Old Female

Case at a Glance

A 31-year-old female presents with a newly discovered pulsatile mass in the upper abdomen, accompanied by visible abdominal pulsations that can be felt synchronous with her heartbeat.

Patient's Story

The patient is a 31-year-old female (height 5'5", weight 135 lbs) who presented with concerns about a recently noticed bulge in her upper abdomen. She reports being able to feel her heartbeat through her abdominal wall, which she describes as a longstanding phenomenon, but the visible bulge is new. She initially considered the possibility of diastasis recti but ruled this out after performing self-examination during abdominal muscle contraction, which did not reveal the characteristic gap or doming associated with this condition. The patient has a medical history significant for depression, anxiety, and alcohol use disorder, all currently well-controlled with medication.

Initial Assessment

Current medications include bupropion (Wellbutrin) and venlafaxine (Effexor) for psychiatric conditions. Family history is notable for hypertension, hypothyroidism, ankylosing spondylitis, and breast cancer. The patient recently underwent routine blood work with normal results and had a right upper quadrant ultrasound performed due to associated abdominal pain, with results pending at the time of presentation.

The Diagnostic Journey

Physical examination revealed a pulsatile mass in the epigastric region. The patient's self-assessment ruled out diastasis recti through manual palpation during muscle contraction. Recent laboratory studies showed normal values across all parameters. Imaging studies included a right upper quadrant ultrasound that was performed but results were not yet available at the time of initial evaluation.

Final Diagnosis

Pending further imaging and clinical correlation. Differential diagnosis includes abdominal aortic prominence, epigastric hernia, or other vascular abnormalities requiring additional imaging studies for definitive diagnosis.

Treatment Plan

Awaiting results of pending right upper quadrant ultrasound. Further imaging studies may be indicated based on initial ultrasound findings. Clinical follow-up recommended for symptom monitoring and review of imaging results.

Outcome and Follow-up

Patient advised to monitor symptoms and return for follow-up once ultrasound results are available. Further diagnostic workup to be determined based on imaging findings and clinical progression.