CASE 2066 Published on 10.09.2003

Cystic adventitial degeneration of the popliteal artery

Section

Cardiovascular

Case Type

Clinical Cases

Authors

Heinze A, Sassen R, Hoeschel M

Patient

45 years, male

Categories

No Area of Interest ; Imaging Technique MR, MR, Ultrasound-Colour Doppler

No Procedure ; No Special Focus ;

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Clinical History

The patient presented with a history of a few months' duration of pain in the right popliteal fossa and calf, mainly while working in the garden in a kneeling position (e.g. picking strawberries).

Imaging Findings

The patient was referred for MRI examination by an orthopaedic surgeon giving a history of a few months' duration of pain in the right popliteal fossa and calf, mainly while working in the garden in a kneeling position (e.g. picking strawberries).
MRI showed a circular lesion around the lumen of the popliteal artery with high signal on T2*-weighted imaging. No other lesion of the knee or surrounding tissue was seen.
Colour-doppler scanning, performed additionally, showed an echo-free zone around the proximal popliteal artery with contact to the arterial wall. The lesion itself contained no flow. On flexion of the knee there was significantly reduced flow and pulsatility of the distal popliteal artery and arteries of the calf.

Discussion

The clinicial history and the imaging with MRI and colour doppler showed the typical features of cystic degeneration of the adventitia of the popliteal artery with popliteal entrapment.
Adventitial degeneration typically occurs in arteries adjacent to joints and ectopic mucin-producing cells, located in the adventitia, are responsible. It is relatively rare and predominantly occurs in men between the ages of 30 and 50 years. In 80% of cases the degeneration is situated in the popliteal artery.
Symptoms are similar to a popliteal stenosis. The disease should be considered if there are no risk factors for arterial occlusive disease. A further differential diagnosis is a haemorrhage of the arterial wall. Initial diagnosis can be made by colour-doppler sonography. In this case the patient was referred for MRI by the orthopaedic surgeon with knee pain.

Differential Diagnosis List

Cystic adventitial degeneration of the popliteal artery

Final Diagnosis

Cystic adventitial degeneration of the popliteal artery

References

[1] Slysko R, Sefranek V, Dulka T, Tomka J, Mondek P, Zita Z.

Cystic degeneration of the adventitia of the popliteal artery - a case report.

Rozhl Chir. 2002 Jun;81(6):297-300. (PMID: 12149873)

[2] Brodmann M, Stark G, Pabst E, Seinost G, Schweiger W, Szolar D, Pilger E.

Cystic adventitial degeneration of the popliteal artery - the diagnostic value of duplex sonography.

Eur J Radiol. 2001 Jun;38(3):209-12. (PMID: 11399375)

[3] Jung EM, Hallermeier J, Schwalbe B, Butter F, Rupp N.

Cystic degeneration of the adventitia of the popliteal artery: ultrasound angiography-aided puncture.

RoFo Fortschr geb Rontgenstr 1997 Oct;167(4):423-6. (PMID: 9417274)

[4] Wali MA, Dewan M, Renno WM, Ezzeddin M.

Mucoid degeneration of the brachial artery: case report and a review of literature.

J R Coll Surg Edinb. 1999 Apr;44(2):126-9. (PMID: 10230208)

Case information