166C ystic adventitial disease (CAD) is a rare condition that usually affects the popliteal artery. It is most commonly found in young or middle-aged men, usually non-smokers, with intermittent claudication. The pathogenesis of the disease is unclear; however, several theories have been postulated (1, 2). Herein we present a histologically proven case of CAD of the popliteal artery in a 53-year-old man. We describe the imaging findings on gray-scale, Doppler and triplex ultrasonography (US), computed tomography (CT) with 3D reconstruction, and digital subtraction angiography (DSA). Case reportA 53-year-old man with a medical history remarkable only for a 30 pack/ year smoking was referred to our department because of a 2-year history of intermittent claudication of the right calf that worsened during the last 4 months. Other than cigarette-smoking, the patient had no risk factors for vascular disease. Clinical examination revealed diminished popliteal and pedal pulses on the affected side. Other clinical and laboratory findings were normal, and the patient was in excellent condition.Gray-scale and Doppler US demonstrated an ovoid cystic structure of about 20 x 15 mm, compressing the right popliteal artery and causing severe narrowing of the lumen. Spectral analysis of the popliteal artery demonstrated an abnormal arterial spectrum proximal to, within, and distal to the stenosis (Fig. 1). Subtle atheromatous changes with no significant arterial stenosis were also found in the arteries of both legs. Diagnosis of CAD was suspected, and the patient was referred for further imaging evaluation.CT angiography of the popliteal artery confirmed the cystic nature of the lesion (23 HU) that was in contact with the popliteal artery, causing almost complete occlusion of the vessel lumen. Small arterial collaterals were also demonstrated. Further evaluation with 3D-CT reconstructions using the volume rendering technique was performed for better preoperative planning (Fig. 2).DSA was then performed in order to demonstrate more clearly the degree of the stenosis, the collaterals, and other potential stenoses from the arteries of the lower limbs not demonstrated in previous studies. DSA demonstrated almost compete occlusion of the right popliteal artery for a length of 15 mm, while there were no other stenoses in the arteries of the lower limbs (Fig. 3).It was finally decided that surgery should be performed because of the patient's persistent symptoms. At surgery, a cystic lesion was found, filled with a viscous, mucous fluid in the wall of the popliteal artery. The wall of the cyst was carefully dissected, and the popliteal artery was decompressed (Fig. 4a). Histopathology of the surgical specimen revealed a section of the wall of a large artery, with findings consistent with CAD (Fig. 4b). CARDIOVASCULAR IMAGING CASE REPORT Cystic adventitial disease of the popliteal arteryMichael Michaelides, Stavroula Pervana, Charis Sotiridadis, Ioannis Tsitouridis ABSTRACT Cystic adventitial disease is a rare condition that usually affect...