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Age / Sex : 60 / M
Age / Sex : 60/M
Chief complaint : Claudication, worsen during walking
1) What is your impression?
Two weeks later, you can see the final diagnosis with a brief discussion of
this case.
* Send Application Answers to In Sook Lee, MD (lis@pusan.ac.kr)
Courtesy : Lee
Sung Moon, Keimyung University
Diagnosis: Popliteal artery entrapment, type 2
Discussion
Findings:
1.
No intrinsic
filling defect in popliteal artery.
2.
Anomalous
origin of medial head of gastrocnemius muscle.
3.
Popliteal
artery passes around and beneath the medial head of gastrocnemius muscle.
4.
Doppler US
shows luminal narrowing during dorsiflexion of ankle.
5.
This case is
bilateral – same findings were noted in right side.
Differential Diagnosis:
Diagnosis:
Popliteal
artery entrapment, type 2.
Discussion:
1.
Popliteal
artery entrapment syndrome (PAES) is uncommon entity
: 0.165% in young mail entering military service, 3.5% in autopsy
: bilateral in 27-67%
2.
Abnormal
relationship between popliteal vessel and neighboring musculotendinous
structures in popliteal fossa resulting in extrinsic arterial compression
3.
Repetitive
insult to the popliteal artery can cause arterial damage and lead to aneurysm,
thromboembolism, arterial thrombosis
: need early diagnosis and treatment
4.
Awareness of
this entity is important
5.
In type I,
the medial head of the gastrocnemius muscle is normal, and the popliteal artery
is displaced medially around and beneath the muscle. In type II, the medial
head of the gastrocnemius muscle arises from an abnormal lateral position. The
popliteal artery descends normally but passes medial to and beneath the muscle.
In type III, the popliteal artery is compressed by an abnormal slip of
gastrocnemius muscle. In type IV, the popliteal artery is entrapped by a
fibrous band or by the popliteus muscle. Type V is any of the four preceding
types that includes the popliteal vein, and type VI is functional PAES (normal
anatomy).
References:
1.
Popliteal
artery disease: Diagnosis and treatment. Wright LB, Matchett WF, Cruz CP, et
al. Radiographics 2004; 24:467-479
2.
Popliteal
artery entrapment syndrome: Role of imaging in the diagnosis. Macedo TA,
Johnson M, Hallett JW, Breen JF. AJR 2003; 181:1259-1265
3.
CT
angiography and MRI in patients with popliteal artery entrapment syndrome. Hai
Z, Guangrui S, Yuan Z, et al. AJR 2008; 191:1760-1766
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