Figure 1
Ultrasound
Ultrasound examination
Popliteal venous aneurysm
SectionCardiovascular
Case TypeClinical Cases
AuthorsCaprara M, Fiocchi F, Rumolo A, Torricelli P.
Connected authors
83 years, female
Clinical History
A 83 year old woman with note fibrous pulmonary disease was admitted to the emergency department for serious dyspnoea and oedema of the left leg. Pneumological clinical examination and serum test (i.e. D-Dimer analysis) excluded pulmonary thrombus-embolism. During clinical examination was found a non-hurting mass, soft at palpation in the left popliteal fossae.
Imaging Findings
US was requested as first diagnostic step revealing a 10 cm mass in the left popliteal fossae, that was inseparable from vascular structures (thrombus?). Nevertheless no flow was appreciable at any side of this lesion at Colour- and Power-Doppler evaluation so the co-existence of a mass could not be excluded (Fig 1). Magnetic resonance imaging (MRI) was performed as a second level examination to understand the nature of these findings. MRI showed an oval polilobulated lesion of 5 cm, not homogeneously hyperintense in T1- and T2-weighted sequences (Fig 2-3) that could be related to haematic content. Due to unsatisfactory renal function of the old lady no venous contrast media could be used but similar-vascular sequences (balanced Turbo Field Echo) showed slow flow within the mass, indicating the vascular origin of the lesion and its relation to the posterior popliteal vein (Fig 4).
Discussion
Popliteal venous aneurysm (PVA) is a rare finding, occurring with a frequency of 1-2 per thousand duplex ultrasound examination of the low extremity venous system [1].
PVA may cause fatal complications (e.g., pulmonary embolism and other thromboembolic episodes) if they remain undiagnosed or untreated. These lesions may have more or less symptomatic manifestation above all in females and more frequently in people over 40 years.
Asymptomatic incidental detection, local lower extremity symptoms, or embolic pulmonary episodes may represent different aspects of manifestation of the same condition.
Most popliteal venous aneurysms are showed with pulmonary embolism or chronic venous disease but usually they are impalpable on clinical examination. The diagnosis is easy with the US and MRI.
US examination shows an hypoechogenic mass and MRI demonstrates haematic content of the lesion and its relation to venous structures [2].
Upon identification, surgical exclusion is advocated to reduce the likelihood of thromboembolic complication [3-7]. Diameter greater than 2 cm is often stated as being an indication for elective operation in symptomatic and asymptomatic popliteal aneurysm [8].
PVA may cause fatal complications (e.g., pulmonary embolism and other thromboembolic episodes) if they remain undiagnosed or untreated. These lesions may have more or less symptomatic manifestation above all in females and more frequently in people over 40 years.
Asymptomatic incidental detection, local lower extremity symptoms, or embolic pulmonary episodes may represent different aspects of manifestation of the same condition.
Most popliteal venous aneurysms are showed with pulmonary embolism or chronic venous disease but usually they are impalpable on clinical examination. The diagnosis is easy with the US and MRI.
US examination shows an hypoechogenic mass and MRI demonstrates haematic content of the lesion and its relation to venous structures [2].
Upon identification, surgical exclusion is advocated to reduce the likelihood of thromboembolic complication [3-7]. Diameter greater than 2 cm is often stated as being an indication for elective operation in symptomatic and asymptomatic popliteal aneurysm [8].
Differential Diagnosis List
Popliteal venous aneurysm thrombosis.Treatment was oral anticoagulation with coumarins due to patient’s age.
tumor
thrombus
Final Diagnosis
Popliteal venous aneurysm thrombosis.Treatment was oral anticoagulation with coumarins due to patient’s age.
References
[1] Attaya H, Gloviczki P, McBane RD 2nd (2009) Popliteal venous aneurysm. Vasc Med 14: 283-284 (PMID: 19651680)
[2] Fiori R, Chiappa R, Gaspari E, Simonetti G (2010) A Rare Case of Popliteal Venous Aneurysm. Case Report Med 2010: 579256. (PMID: 20224754)
[3] Symvoulakis EK, Klinis S, Peteinarakis I, Kounalakis D, Antonakis N, Tsafantakis E, Lions C (2008) Diagnosing a popliteal venous aneurysm in a primary care setting: a case report. J Med Case Report 2:307 (PMID: 18808663)
[4] Winchester D, Pearce WH, McCarthy WY, McGee GS, Yao JS (1993) Popliteal venous aneurysm. Surgery 114(3):600-7 (PMID: 8367818)
[5] Christenson JT (2007) Popliteal venous aneurysm: a report on three cases present with cronic venous insufficiency without embolic events. Phlebology 22(2):56-9 (PMID: 18268850)
[6] Mertens R, Corvalan F, Kramer A, Valdes F, Arroyo C, Saez C (1999) Popliteal vein aneurysm. Rev Med Chil 127(1):78-81 (PMID: 10436684)
[7] Nasr W, Babbit R, Eslami MH (2007) Popliteal vein aneurysm: a case report and review of literature. Vasc Endovascular Surg 41(6):551-5 (PMID: 18166639)
[8] Galland RB (2007) Popliteal aneurysms: from John Hunter to the 21st century. Ann R Coll Surg Engl 89(5):446-71 (PMID: 17688716)
Case information
| URL: | https://www.eurorad.org/case/8984 |
| DOI: | 10.1594/EURORAD/CASE.8984 |
| ISSN: | 1563-4086 |
Figure 2
MRI
MRI
Figure 3
MRI
MRI
Figure 4
Figure 4
Figure 4
Ultrasound
Ultrasound examination
MRI
MRI
MRI
MRI
Figure 4
Figure 4