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					2004 Texas Radiological
        Society

UNKNOWN CASES
   Vascular
     Justin Q. Ly, MD
    Douglas P. Beall, MD

    Wilford Hall Medical Center
          San Antonio, TX
                 VASCULAR
• 79-year-old male

   – Right knee pain and posterior fullness

   – Denies recent trauma

   – Plainfilm radiography was unremarkable
Courtesy Peterson JJ, Mayo
Clinic, Jacksonville, FL.
Courtesy Peterson JJ Mayo Clinic,
Jacksonville, FL.
Courtesy Peterson JJ Mayo Clinic,
Jacksonville, FL.
Courtesy Peterson JJ, Mayo
Clinic, Jacksonville, FL.
Courtesy Peterson JJ Mayo Clinic,
Jacksonville, FL.
2004 Texas Radiological
        Society

   Diagnosis for
   Vascular Case
     Justin Q. Ly, MD
    Douglas P. Beall, MD

    Wilford Hall Medical Center
          San Antonio, TX
DDX Popliteal Artery Occlusion
• Trauma (no hx)
• Embolism (acute sxs)
• Popliteal entrapment syndrome (narrowing
  with dorsi- or plantar flexion)
• Popliteal aneurysm
• Cystic adventitial disease
 Pop vein patent


               Multiloculated cystic mass
                    Pop art not well seen




Courtesy Peterson JJ Mayo Clinic,
Jacksonville, FL.                           Angio: Pop art occlusion with
                                            reconstitution via collaterals
   Cystic Adventitial Disease (CAD)
• Characterized by cystic degen of peripheral
  arteries - most commonly pop art
• Claudication-young healthy males leading sympt,
  but can occur at any age - usually in pts w/o
  atherosclerosis
• Etiol unclear
• Results in cystic spaces between medial and
  adventitial layers with progressive enlargement
  which eventually compromises arterial lumen

 Tsolakis IA, et al. Cystic advential disease of the popliteal artery: diagnosis and treatment. Eur J Vasc Endovasc Surg.
                                                      1998;15:188-194.
          Cystic Adventitial Disease
• Color Dop US-pop art enlargement, increased peak syst velocities,
  intramural cyst lies eccentric to art, contains low level echoes/shows
  no internal flow

• CT-pop art compression by nonenhancing structure
  related to art wall

• Arteriography shows smoothly tapered eccentric or
  concentric narrowing of art—mimics findings of external
  compression
• Aspiration yields mucinous gel

• Tx – surgical bypass with excellent prognosis; surg evac of cysts
  with maintenance of native artery
  2004 Texas Radiological
          Society

  UNKNOWN CASES
        Justin Q. Ly, MD
       Douglas P. Beall, MD

       Wilford Hall Medical Center
             San Antonio, TX




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