2004 Texas Radiological Society UNKNOWN CASES Vascular

1
2004 Texas Radiological SocietyUNKNOWN
CASESVascular

• Justin Q. Ly, MD
• Douglas P. Beall, MD
• Wilford Hall Medical Center
• San Antonio, TX

2
VASCULAR

• 79-year-old male
• Right knee pain and posterior fullness
• Denies recent trauma
• Plainfilm radiography was unremarkable

3
Courtesy Peterson JJ, Mayo Clinic, Jacksonville,
FL.
4
Courtesy Peterson JJ Mayo Clinic, Jacksonville,
FL.
5
Courtesy Peterson JJ Mayo Clinic, Jacksonville,
FL.
6
Courtesy Peterson JJ, Mayo Clinic, Jacksonville,
FL.
7
Courtesy Peterson JJ Mayo Clinic, Jacksonville,
FL.
8
2004 Texas Radiological SocietyDiagnosis
forVascular Case

• Justin Q. Ly, MD
• Douglas P. Beall, MD
• Wilford Hall Medical Center
• San Antonio, TX

9
DDX Popliteal Artery Occlusion

• Trauma (no hx)
• Embolism (acute sxs)
• Popliteal entrapment syndrome (narrowing with
  dorsi- or plantar flexion)
• Popliteal aneurysm
• Cystic adventitial disease

10
Pop vein patent
Multiloculated cystic mass Pop art not well seen
Courtesy Peterson JJ Mayo Clinic, Jacksonville,
FL.
Angio Pop art occlusion with reconstitution via
collaterals
11
Cystic Adventitial Disease (CAD)

• Characterized by cystic degen of peripheral
  arteries - most commonly pop art
• Claudication-young healthy males leading sympt,
  but can occur at any age - usually in pts w/o
  atherosclerosis
• Etiol unclear
• Results in cystic spaces between medial and
  adventitial layers with progressive enlargement
  which eventually compromises arterial lumen

Tsolakis IA, et al. Cystic advential disease of
the popliteal artery diagnosis and treatment.
Eur J Vasc Endovasc Surg. 199815188-194.
12
Cystic Adventitial Disease

• Color Dop US-pop art enlargement, increased peak
  syst velocities, intramural cyst lies eccentric
  to art, contains low level echoes/shows no
  internal flow
• CT-pop art compression by nonenhancing structure
  related to art wall
• Arteriography shows smoothly tapered eccentric or
  concentric narrowing of artmimics findings of
  external compression
• Aspiration yields mucinous gel
• Tx surgical bypass with excellent prognosis
  surg evac of cysts with maintenance of native
  artery

13
2004 Texas Radiological SocietyUNKNOWN CASES

• Justin Q. Ly, MD
• Douglas P. Beall, MD
• Wilford Hall Medical Center
• San Antonio, TX

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