Presentation
Constant lower left leg pain and swelling following exercise 7 days prior. D-dimer levels were elevated at 4.9.
Patient Data
Duplex ultrasound of a dilated left superficial femoral artery measuring 5,6 cm showing a mural thrombus. A faint Doppler signal is present.
Coronal and axial CTA images of the abdomen and lower extremities showing multiple aneurysms and ectasias in both peripheral and central arteries, including a 57 mm infrarenal abdominal aorta aneurysm (AAA), a 38 mm aneurysm in the right common iliac artery (CIA), a 13 mm ectasia in the left internal iliac artery (IIA), a 38 mm aneurysm in the right superficial femoral artery (SFA) with a mural thrombus, a 19 mm ectasia in the left common iliac artery, and a 56 mm aneurysm in the left superficial femoral artery with a mural thrombus.
Case Discussion
Ultrasound revealed a substantial left-sided superficial femoral artery aneurysm with a mural thrombus. Superficial femoral artery aneurysms are a rare vascular anomaly with around 200 reported cases 1,2. To comprehensively evaluate the pathology, CTA was employed. It corroborated the superficial femoral artery aneurysm and unveiled multiple peripheral and central arterial pathologies, including an infrarenal abdominal aortic aneurysm, a common iliac artery aneurysm, and a contralateral superficial femoral artery aneurysm.
Key learning point:
this case emphasizes the importance of considering the possibility of concurrent aneurysms when one is identified 3
identifying a true superficial femoral artery aneurysm on ultrasound and CT angiography
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