Deutsche medizinische Wochenschrift (1946) · 2023
[Rare cause of calf pain in a 56-year-old female patient: cystic adventitial degeneration of the popliteal artery].
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Stammler Frank, Wenzler Marion
Аннотация
INTRODUCTION: Cystic adventitial degeneration (CAD) is a rare vascular disease, affects mostly middle-aged men, and as a nonatherosclerotic disease, is an uncommon differential diagnosis of intermittent claudication.
CASE HISTORY: A 56-year-old female patient presented to our medical office because of unexplained right-sided calf pain that was not constantly load-dependent. The complaints fluctuated considerably with longer symptom-free intervals.
EXAMINATION AND FINDINGS: Clinically, the patient presented regular pulses, which were maintained even with provocative maneuvers such as plantar flexion and knee flexion. Duplex sonography showed cystic masses around the popliteal artery. On MRI examination, a tubular tortuous connection to the knee joint capsule also appeared to be visualizable. A diagnosis of cystic adventitial degeneration was made.
THERAPY AND COURSE: In the absence of constant impairment of walking performance with symptom-free intervals as well as morphological and functional signs of stenosis, interventional or surgical therapy was not desired by the patient. Short-term follow-up revealed stable clinical and sonomorphologic findings over an observation period of 6 months so far.
DISCUSSION: CAD should also be considered in female patients with atypical leg symptoms. There are no uniform treatment recommendations for CAD, which is why it is a challenge to select the optimal, usually interventional procedure. In patients with few symptoms and no critical ischemia, a conservative approach with close follow-up may be justified, as in our case report.
CASE HISTORY: A 56-year-old female patient presented to our medical office because of unexplained right-sided calf pain that was not constantly load-dependent. The complaints fluctuated considerably with longer symptom-free intervals.
EXAMINATION AND FINDINGS: Clinically, the patient presented regular pulses, which were maintained even with provocative maneuvers such as plantar flexion and knee flexion. Duplex sonography showed cystic masses around the popliteal artery. On MRI examination, a tubular tortuous connection to the knee joint capsule also appeared to be visualizable. A diagnosis of cystic adventitial degeneration was made.
THERAPY AND COURSE: In the absence of constant impairment of walking performance with symptom-free intervals as well as morphological and functional signs of stenosis, interventional or surgical therapy was not desired by the patient. Short-term follow-up revealed stable clinical and sonomorphologic findings over an observation period of 6 months so far.
DISCUSSION: CAD should also be considered in female patients with atypical leg symptoms. There are no uniform treatment recommendations for CAD, which is why it is a challenge to select the optimal, usually interventional procedure. In patients with few symptoms and no critical ischemia, a conservative approach with close follow-up may be justified, as in our case report.