Clinical Presentation Analysis

The patient presents with a specific set of symptoms and a physical finding:

• Buttock Claudication: Pain in the buttocks upon exertion, indicating insufficient blood supply to the gluteal muscles.
• Impotence: Suggests compromised blood flow to the pelvic region, potentially affecting the internal pudendal arteries.
• Bruit over lower abdomen: An abnormal sound indicating turbulent blood flow, likely due to stenosis or occlusion in the abdominal aorta or its major branches (iliacs).

Differential Diagnosis Evaluation

Let's evaluate the options based on the clinical picture:

• Bilateral iliac artery occlusion: Affects blood flow to the legs but might not fully explain the lower abdominal bruit if the aorta itself is not involved.
• Aortoiliac occlusion: This condition involves blockage in the distal aorta and/or the iliac arteries. It classically causes buttock claudication and can lead to impotence (part of Leriche syndrome). The bruit in the lower abdomen strongly suggests pathology in this aortoiliac segment.
• Bilateral iliofemoral occlusion: Extends into the femoral arteries. While causing claudication, the bruit localization points more proximally than just the iliofemoral segment.
• Bilateral femoropopliteal occlusion: Primarily affects blood flow to the lower legs, typically causing calf claudication, and is unlikely to cause buttock claudication or impotence. A lower abdominal bruit is not characteristic.

Conclusion

The combination of buttock claudication, impotence, and a bruit localized to the lower abdomen is highly suggestive of blockage affecting the lower aorta and extending into the iliac arteries. Therefore, Aortoiliac occlusion is the most fitting clinical diagnosis.