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 : 양익,  Ik Yang, 한림대학교강남성심병원, Hallym University Kangnam Sacred Heart Hospital

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.