Radiological Case: Cystic adventitial disease

Cystic adventitial disease masquerading as ganglion disease: a rare cause of intermittent claudication

“…CAD is a rare cause of intermittent claudication, accounting for 1 in 1200 presentations 1–4. Mucoid cyst formation within the adventitia of an artery leads to luminal narrowing.…”

“…Less than 400 cases of CAD have been reported in the literature, and of those 85% of cases have been reported in the popliteal artery 1 3 6–8. CAD is four to five times more likely to occur in men than women, commonly presenting in people in their fifth and sixth decades of life without significant risk factors for atherosclerotic disease 1–4 9 10. It is usually unilateral 1 3 6–8 11…”

“…CAD is four to five times more likely to occur in men than women, commonly presenting in people in their fifth and sixth decades of life without significant risk factors for atherosclerotic disease 1–4 9 10. It is usually unilateral 1 3 6–8 11…”

“…Though the aetiology of CAD is unknown, four theories have been proposed to clarify the pathophysiology of CAD: repeated trauma prompting adventitial degeneration; a systemic process; the incorporation of mucin-producing mesenchymal cells into vessel adventitia during embryological development; and migration of synovial cysts that implant into adventitia through communicating branches 1 2 4 9–14. The synovial cyst hypothesis is becoming more widely accepted, and it has been demonstrated that the middle genicular artery is a communicating branch between the joint and the popliteal artery 11.…”

“…CAD can be identified using digitally subtracted angiography, duplex ultrasonography, CT angiography (CTA) and MRA. CAD can be diagnosed on conventional angiography by identifying a smooth contour of contrast above and below the lesion (scimitar sign), or an hourglass appearance seen with concentric compression 1–3 13 15. When seen during duplex ultrasonography, a hypoechoic or anechoic cystic structure can be seen with or without septations, and the lumen of the artery may appear stenosed with either turbulent or absent flow on Doppler 1 2 10.…”