Cystic adventitial degeneration of the popliteal artery

Author(s)

Heinze A, Sassen R, Hoeschel M

Patient

male, 45 year(s)

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.

Final Diagnosis

References

Citation

Heinze A, Sassen R, Hoeschel M (2003, Sep 11).

Cystic adventitial degeneration of the popliteal artery, {Online}.

URL: http://www.eurorad.org/case.php?id=2066

DOI: 10.1594/EURORAD/CASE.2066

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Published 11.09.2003
DOI 10.1594/EURORAD/CASE.2066
Section Cardiovascular
Case Type Clinical Cases
Difficulty Resident
Views 5804
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Figure 1
Sagittal view, T2*-weighted MR images

a

b

Sagittal view showing the degeneration surrounding the popliteal artery like a cuff. High signal on T2*-weighted image.

Area of Interest: unknown; Imaging Technique: Sagittal view, T2*-weighted MR images;

Same view, magnification.

Area of Interest: unknown; Imaging Technique: Sagittal view, T2*-weighted MR images;
Figure 2
Axial view, T2*-weighted MR images

a

b

Axial view of the lesion surrounding the artery.

Area of Interest: unknown; Imaging Technique: Axial view, T2*-weighted MR images;

Same view, magnification.

Area of Interest: unknown; Imaging Technique: Axial view, T2*-weighted MR images;
Figure 3
Sagittal colour-doppler US image of the lesion

Sagittal view showing the vein (top) and artery (bottom) and the echo-free lesion surrounding the artery.

Area of Interest: unknown; Imaging Technique: Sagittal colour-doppler US image of the lesion;