Cystic adventitial disease
Citation, DOI & case data
Left calf and knee pain for several months, that has been exacerbated after intense walking in the last few days
Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines.
US popliteal fossa
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Ultrasound examination of the popliteal region. There are several cystic lesions around the popliteal artery. There is no compromise of the lumen.
With color Doppler ultrasound the cystic images do not show flow within them. The artery is patent without signs of stenosis during rest.
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MRI shows T2 hyperintense lesions around the popliteal artery in that are hypointense on T1WI.
Cystic disease of the adventitia is more frequent in males and predominantly affects the popliteal artery, although it can affect other arteries. The cysts contain a proteinaceous or mucinous fluid, and surround the artery. They can generate extrinsic compression of the arterial lumen, especially during exercise, which is why they produce claudication. At rest, they do not usually give symptoms. Within the possible etiologies, trauma of the artery wall is considered the most probable.
Ultrasound is a very good method for the examination of the painful knee and to rule out other differential diagnoses such as Baker cyst or deep vein thrombosis. The cysts are observed as periarterial anechoic images, which do not show flow with color or power Doppler.
With Doppler ultrasound, dynamic maneuvers can be performed and the compression of the lumen can be demonstrated with muscle contraction.
On MRI, the cysts are hyperintense on T2, and are usually hypointense on T1 although this depends on the mucin or protein content.
- 1. Kawarai S, Fukasawa M, Kawahara Y. Adventitial Cystic Disease of the Popliteal Artery. Ann Vasc Dis. 2012;5(2):190-3. doi:10.3400/avd.cr.11.00069 - Pubmed
- 2. Mino M, Garrigues D, Pierce D, Arko F. Cystic Adventitial Disease of the Popliteal Artery. J Vasc Surg. 2009;49(5):1324. doi:10.1016/j.jvs.2008.10.060 - Pubmed
- 3. Wright L, Matchett W, Cruz C et al. Popliteal Artery Disease: Diagnosis and Treatment. Radiographics. 2004;24(2):467-79. doi:10.1148/rg.242035117 - Pubmed
- 4. Tsilimparis N, Hanack U, Yousefi S, Alevizakos P, Rückert R. Cystic Adventitial Disease of the Popliteal Artery: An Argument for the Developmental Theory. J Vasc Surg. 2007;45(6):1249-52. doi:10.1016/j.jvs.2007.01.051 - Pubmed
- 5. Peterson J, Kransdorf M, Bancroft L, Murphey M. Imaging Characteristics of Cystic Adventitial Disease of the Peripheral Arteries: Presentation as Soft-Tissue Masses. AJR Am J Roentgenol. 2003;180(3):621-5. doi:10.2214/ajr.180.3.1800621 - Pubmed
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