Doppler ultrasonography and exercise testing in diagnosing a popliteal artery adventitial cyst

Abstract

We describe popliteal arterial adventitial cystic disease which causes intermittent claudication in a young athletic man, with atypical manifestation, without loss of foot pulses on knee flexion nor murmur in the popliteal fossa. The findings obtained from Magnetic Resonance Imaging were nondiagnostic. The diagnosis resulted from Echo-Doppler ultrasonography along with peak exercise testing. Ultrasonography also provided useful physiopathological informations suggesting that a popliteal artery adventitial cyst can become symptomatic if muscle exertion increases fluid pressure within the cyst, enough to cause hemodynamically significant endoluminal stenosis. Rapid diagnosis is essential to prevent progressive claudication threatening limb viability. To guarantee this professional sportsman a reliable and durable outcome, instead of less aggressive management, we resected the involved arterial segment and interposed an autologous saphenous-vein graft.

Cystic Adventitial Disease of the Popliteal Artery: Report on Three Cases and Review of the Literature

“…Similarly, a simple doppler image would not show changes in the blood flow in these cases. In some instances, the stenosis is visible only in images obtained during knee hyperflexion 27 , such as in case of the Ishikawa sign in physical examination. However, this manoeuvre can also fail as Taurino et al 27 reported a case of the popliteal artery affected with CAD with no luminal stenosis on MRA and no peripheral perfusion deficit on duplex ultrasound seen during knee hyperflexion.…”

“…In some instances, the stenosis is visible only in images obtained during knee hyperflexion 27 , such as in case of the Ishikawa sign in physical examination. However, this manoeuvre can also fail as Taurino et al 27 reported a case of the popliteal artery affected with CAD with no luminal stenosis on MRA and no peripheral perfusion deficit on duplex ultrasound seen during knee hyperflexion. In addition, MRA failed to visualise the adventitial cyst clearly in this case, and the definite diagnosis of popliteal artery CAD came from duplex ultrasound.…”

“…On the other hand, the histochemical markers for synovium are absent in adventiti al cysts 38,44 . The microtraum atic theory was postulated on the basis of cases of popliteal artery CAD in young adults employed in heavy physical labour 50 , and in patients engaged in extreme sports and vigorous exercise [25][26][27][28] . In other patients, a definite traumatic event preceding the disclosure of CAD was identified such as falling from a bus 51 , pedal cycle accident 52 and repeated kneeling 53 .…”

“…It usually manifests in the 4 th or 5 th decade of life and is mostly unilateral even though a few cases of bilateral involvement 16,17 and of the occurrence in very young [18][19][20] and old patients 21,22 have also been reported. The patients are often otherwise healthy, without signs of atherosclerotic disease or cardiovascular risk factors, and some are active sportsmen 15,16,[23][24][25][26][27][28] . Most reported cases are from Europe and Japan 24 .…”

Cystic Adventitial Disease of the Common Femoral Artery. Case Report and Review of the Literature

“…DUS provides useful information in suggesting CAAD less invasively subsequent MDCT with 3-dimensional volume rendering and MRA excludes a systemic atherosclerotic lesion. 8) Open surgery included removal of cystic lesion with CFA and subsequent interposition using great saphenous vein graft is the best therapeutic option for CAAD. Percutaneous cystic aspiration under US guide is not always possible because of the high viscosity of the content and multillocular cyst and a high recurrence rate has been described due to the mucin-secreting cells which still remain.…”