“Intermittent Claudication Intermittence” as a Manifestation of Adventitial Cystic Disease Communicating with the Knee Joint

Buijsrogge, Marc P.; Meij, Suzan van der; Korte, Jan H.; Fritschy, Wilbert M.

doi:10.1007/s10016-006-9066-3

Cited by 25 publications

(16 citation statements)

References 2 publications

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“…Similar intermittent fluctuating symptoms and findings, documented on serial examinations in Cases 1 and 2 in this paper, have been described by others as occurring in patients with intraneural ganglia; 1,9,25,32 these dynamic changes in intraneural cysts are directly analogous to those seen in other types of cysts, ranging from common ganglion cysts to extraneural ganglia at the superior tibiofibular joint or spinoglenoid notch, 7,23 spinal facet-related cysts, [4][5][6]11,14,20,22,39 and rare adventitial cysts. 3,24,26,28 Nevertheless, other examples of proximal extension of a cyst into the sciatic nerve 2 or of distal descent of a cyst into its terminal branches 40 have gone unrecognized on MR images (Fig. 16).…”

Section: Pressure Fluxes and Dynamic Appearancesmentioning

confidence: 98%

Dynamic phases of peroneal and tibial intraneural ganglia formation: a new dimension added to the unifying articular theory

Spinner¹,

Amrami²,

Wolanskyj³

et al. 2007

FOC

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Object The pathogenesis of intraneural ganglia has been a controversial issue for longer than a century. Recently the authors identified a stereotypical pattern of occurrence of peroneal and tibial intraneural ganglia, and based on an understanding of their pathogenesis provided a unifying articular explanation. Atypical features, which occasionally are observed, have offered an opportunity to verify further and expand on the authors' proposed theory. Methods Three unusual cases are presented to exemplify the dynamic features of peroneal and tibial intraneural ganglia formation. Results Two patients with a predominant deep peroneal nerve deficit shared essential anatomical findings common to peroneal intraneural ganglia: namely, 1) joint connections to the anterior portion of the superior tibiofibular joint, and 2) dissection of the cyst along the articular branch of the peroneal nerve and proximally. Magnetic resonance (MR) images obtained in these patients demonstrated some unusual findings, including the presence of a cyst within the tibial and sural nerves in the popliteal fossa region, and spontaneous regression of the cysts, which was observed on serial images obtained weeks apart. The authors identified a clinical outlier, a case that could not be understood within the context of their previously reported theory of intraneural ganglion cyst formation. Described 32 years ago, this patient had a tibial neuropathy and was found at surgery to have tibial, peroneal, and sciatic intraneural cysts without a joint connection. The authors' hypothesis about this case, based on their unified theory, was twofold: 1) the lesion was a primary tibial intraneural ganglion with proximal extension followed by sciatic cross-over and distal descent; and 2) a joint connection to the posterior aspect of the superior tibiofibular joint with a remnant cyst within the articular branch would be present, a finding that would help explain the formation of different cysts by a single mechanism. The authors proved their hypothesis by careful inspection of a recently obtained postoperative MR image. Conclusions These three cases together with data obtained from a retrospective review of the authors' clinical material and findings reported in the literature provide firm evidence for mechanisms underlying intraneural ganglia formation. Thus, expansion of the authors' unified articular theory permits understanding and elucidation of unusual presentations of intraneural cysts. Whereas an articular connection and fluid following the path of least resistance was pivotal, the authors now incorporate dynamic aspects of cyst formation due to pressure fluxes. These basic principles explain patterns of ascent, cross-over, and descent down terminal nerve branches based on articular connections, paths of diminished resistance to fluid flow within recognized anatomical compartments, and the effects of fluctuating pressure gradients.

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Section: Pressure Fluxes and Dynamic Appearancesmentioning

confidence: 98%

Dynamic phases of peroneal and tibial intraneural ganglia formation: a new dimension added to the unifying articular theory

Spinner¹,

Amrami²,

Wolanskyj³

et al. 2007

FOC

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“…Finally, the developmental theory suggests that mucin is secreted by mucin-secreting mesenchymal cells from nearby joints that incorrectly migrated to the adventitia during embryogenesis. In some cases, connections of the cyst with the capsule of the adjacent joint were documented, supporting the latter theory (3,7,8).…”

Section: Discussionmentioning

confidence: 55%

Cystic adventitial disease of the popliteal artery

Michaelides

Pervana²,

Sotiridadis³

et al. 2009

Diagn Interv Radiol

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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...

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“…2) Cases of ACD communication to the knee joint have been reported, 3,4) indicative of a synovial or ganglion theory. However, in the present case, there was no communication between the cystic lesion and the knee joint.…”

Section: Discussionmentioning

confidence: 99%

A Case of Adventitial Cystic Disease of the Popliteal Artery Progressing Rapidly after Percutaneous Ultrasound-guided Aspiration

Seo

Fujii

Aoyama

et al. 2014

Annals of Vascular Diseases

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Adventitial cystic disease is a rare non-atherosclerotic vascular disease. We report a 36-year-old man with right intermittent claudication by adventitial cystic disease. computed tomography (CT) and magnetic resonance imaging (MRI) revealed an ovoid cystic mass compressing the right popliteal artery and causing severe stenosis of the lumen. Percutaneous aspiration was performed, which improved his symptoms. However, he complained of identical intermittent claudication two weeks later. Radiographic findings revealed that the cystic lesion had progressed rapidly. The cystic lesion was resected and the affected arterial segment was interposed. We consider that conventional surgical intervention remains the favored treatment option in the management of adventitial cystic disease.

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“Intermittent Claudication Intermittence” as a Manifestation of Adventitial Cystic Disease Communicating with the Knee Joint

Cited by 25 publications

References 2 publications

Dynamic phases of peroneal and tibial intraneural ganglia formation: a new dimension added to the unifying articular theory

Dynamic phases of peroneal and tibial intraneural ganglia formation: a new dimension added to the unifying articular theory

Cystic adventitial disease of the popliteal artery

A Case of Adventitial Cystic Disease of the Popliteal Artery Progressing Rapidly after Percutaneous Ultrasound-guided Aspiration

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