CASE 13469 Published on 16.03.2016

Rare cause of common femoral artery compression


Musculoskeletal system

Case Type

Clinical Cases


Ankur Srivastava, Praneal Sharma & Sugendran Pillay

43 Westmoreland Road,
Leumeah, NSW,
2560, Australia

56 years, male

Area of Interest Musculoskeletal system, Cardiovascular system, Interventional non-vascular ; Imaging Technique CT, MR, MR-Angiography
Clinical History
A 56-year-old male patient presented to the emergency department with intermittent claudication for the past 6 weeks after a work accident and hip joint trauma. He had no risk factors for atherosclerosis and upon examination there was no signs of peripheral vascular disease.
Imaging Findings
A computed tomography (CT) of the hips was undertaken which demonstrated a cystic lesion, anterior to the right common femoral artery (CFA) and vein (CFV) (Fig. 1).

To further assess the lesion, magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) of the hips was undertaken and demonstrated a fluid-filled cyst which originated from the right hip labrum and caused indentation of the right CFA on the MRA (Fig. 2).

After discussion with the patient, non-surgical treatment with CT guided aspiration was decided as the option of choice to relieve the patient of his symptoms (Fig. 3). However, ultrasound-guided aspiration of the cyst is another and possibly a better option than CT with the benefit of real-time and Doppler imaging.
The majority of vasculogenic intermittent claudication is due to endoluminal atherosclerosis with typical cardiovascular risk factors. Intermittent claudication in the absence of such factors should point towards a few uncommon but important causes of claudication that should be promptly diagnosed [1]. Some uncommon causes include vasculitis, cystic adventitial disease, popliteal entrapment syndrome, fibromuscular dysplasia and endofibrosis of the iliac artery [1, 2].
Paralabral cysts in the hip are rare and can be asymptomatic or associated with trauma, capsular laxity, degenerative disease and hip arthroplasty [3, 4]. It is even rarer for them to cause nerve or vascular compression. Select cases of paralabral cysts causing CFV [5] and sciatic nerve compression [6] have been described.

Cystic lesions that occur near the joint are classified as either ganglionic or synovial cysts and cannot be distinguished on MRI. Thus, acetabular paralabral cysts are named due to their proximity to the acetabular labrum.
Paralabral cysts associated with labral tears generally do not regress without intervention and can often grow over time leading to increased risk of neurovascular compression. Arthroscopic debridement or surgical excision of the cysts are the treatment of choice [5, 7, 8]. In this case, MRI for assessment of a labral tear was not performed but is very important for complete assessment and guiding management.

Peripheral venous [5], arterial [9] and nerve [6, 8, 9] compression due to paralabral cysts has been described. Bystrom et al have described the only case of CFA and CFV compression due to a paralabral cyst before. The exact pathophysiology is not clear but speculations are that loss of congruity between femoral head and acetabulum lead to increased intra-articular pressure which forces synovial fluid through the labral tear and forms a cyst [4, 7]. Non-operative treatment options for peri-articular ganglion cysts and paralabral cysts include image-guided aspiration, however, with recurrence rates of up to 44% [8].
Generally in the shoulder and knee, arthroscopic debridement and cyst evacuation results in much lower recurrence rates and resolution of neurovascular compression [8].

In this case, the patient opted for non-surgical management with CT-guided cyst evacuation and decompression of the arterial impingement. The patient was subsequently followed-up 4 weeks later with complete recovery from the hip pain and claudication symptoms.
Differential Diagnosis List
CFA compression from acetabular paralabral cyst
External compression of CFA by tumour
Direct trauma to CFA
Intervention to CFA
Final Diagnosis
CFA compression from acetabular paralabral cyst
Case information
DOI: 10.1594/EURORAD/CASE.13469
ISSN: 1563-4086