HSS Ultrasound of the Month Case #85

Clinical History A 71 year old male presents with fullness in the left popliteal fossa and some pain with walking.

On exam, the patient has palpable fullness in the lateral aspect of the popliteal fossa with diffuse tenderness in the posterior aspect of the proximal calf.

Clinical concern was for deep venous thrombosis.

Doppler ultrasound evaluation of the left lower extremity was requested.

Ultrasound of the Month – Case 85

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Ultrasound of the Month – Case 85

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Ultrasound of the Month – Case 85

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Ultrasound of the Month – Case 85

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Diagnosis: No left lower extremity deep venous thrombosis.

Thrombosed popliteal artery aneurysm.

Management Vascular surgery at NYP was consulted.

CT angiogram of the abdomen with lower extremity run off was ordered to assess for associated abdominal aortic aneurysm, as well as to better evaluate the popliteal artery aneurysm.

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Discussion

Aneurysmal dilatation of the popliteal artery is defined as an arterial diameter > 1.5 x the normal popliteal artery diameter, which ranges from 0.7-1.1 cm.

Most popliteal artery aneurysms (PAAs) are categorized as true aneurysms, as they are comprised of all three blood vessel wall layers, the intima, media and adventitia.

True PAAs are the most prevalent peripheral artery aneurysm.

Risk factors associated with PAAs include advanced age, male gender, atherosclerosis, hypertension, and smoking.

An increased incidence of concomitant aneurysms is seen with PAAs, and it is thus imperative to screen for coexisting abdominal aortic and contralateral PAAs.

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Discussion

Many patients with PAAs are asymptomatic; however, symptoms related to PAAs include lower extremity claudication, rest pain or ischemia, which may result from thrombosis or distal embolization.

Ultrasound is the imaging modality of choice to diagnose PAAs and can assess for aneurysm patency and thrombus burden.

Early diagnosis of PAAs is essential, as they have the potential to result in thrombosis, distal embolization and may even rupture.

PAAs > 2 cm, even when asymptomatic, as well as those < 2 cm with substantial associated thrombus are typically repaired either via an endovascular or open approach, due to the high incidence of associated complications.

Ultrasound of the Month â&#x20AC;&#x201C; Case 85

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