Weekly Case

Title : Case 688

Age / Sex : 57 / M


Chief complaint : Left leg pain, intermittent claudication (onset : 2 weeks ago)

What is your diagnosis?

Two weeks later, you can see the final diagonosis with a brief discussion of this case (Please submit only one answer).


Courtesy : 
양익Ik Yang, 한림대학교강남성심병원, Hallym University Kangnam Sacred Heart Hospital


 


Diagnosis:

Cystic adventitial disease(CAD) of popliteal artery



Discussion


Findings:


Popliteal artery was compressed by a non-enhancing structure related to the arterial wall.


 


Differential Diagnosis:


Popliteal artery entrapment syndrome


Popliteal artery aneurysm,


Baker cyst


 


Discussion:


Cystic adventitial disease(CAD) is a rare vascular condition that is characterized by a collection


of a gelatinous material rich in mucoproteins and mucopolysaccharides, located between the adventitia and the middle layer of the vessel wall, compressing the lumen of the artery.


 


CAD mainly affects the popliteal artery(85%), although bilateral involvement has also been reported and the external iliac, common femoral, radial and ulnar arteries have been affected..


 


Symptoms


Usually presents as intermittent claudication during exercise.


 


Epidemiology :


Men aged between 40 and 50 (over 80%).


M : F = 15: 1


 


Pathogenesis


Still under debate, trauma, ganglion, systemic disorder, and embryonic development have been proposed.


 


Characteristic imaging findings


Ultrasound :


Anechoic or hypoechoic cystic structures concentric or eccentric to the artery, often with resultant stenosis.


Abnormal arterial spectrum proximal to, within, and distal to the stenosis.


 


CT angiography :


Compressed popliteal artery by a nonenhancing structure that was related to the arterial wall.


The typical hourglass sign (concentric, extrinsic compression) or scimitar sign (eccentric, extrinsic compression) of the popliteal artery seen can be seen.


 


Treatment


Surgical evacuation of the cysts with maintenance of the native artery appears to be the preferred treatment.


 


References:


Bae YA, Kim HB, Jeon EY, Hwang HS, Lee IJ, Lee Y, Bae SH. Cystic Adventitial Disease of the Popliteal Artery as Demonstrated by MDCT Angiography: A Case Report. J Korean Radiol Soc. 2006 Apr;54(4):265-268


Michaelidis M, Pervana S, Sotiridadis C, Tsitouridis I. Cystic adventitial disease of the popliteal artery. Diagn Interv Radiol. 2009;17:166–68.


 



Correct Answer
Total applicants 28 Correct answers 26
Name Institution
윤유성 순천향대 부천병원, 전문의
이현규 전문의
장민영 국민건강보험공단 일산병원, 전문의
강지희 전문의
김기욱 전문의
조영민 전문의
김동언 서울아산병원, 전문의
이규정 국군대전병원, 전문의
김형민 연세의대 강남세브란스병원, 전문의
박진희 서울아산병원, 전문의
이동규 경인지방병무청, 전문의
이진영 전문의
권기언 서울아산병원, 전문의
변성환 전문의
전인환 전문의
임윤진 단국대학교병원, 전공의
이혜란 전문의
여현정 전문의
조신영 전문의
백승진 분당차병원, 전공의
강건우 전문의
이민욱 충남대학교병원, 전문의
박서영 전문의
김성진 365병원, 전문의
윤나연 전공의
노근탁 전문의
Semi-Correct Answer
Total applicants 28 Semi-Correct answers 2
최형인 군의관, 전문의
이광재 예수병원, 전문의


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