Popliteal artery entrapment syndrome: a rare diagnosis for calf pain

摘要

An 18-year-old man presented with a long history of occasional right calf pain and fullness. He also complained that over the last year his right foot PICTORIAL MEDICINE became pale and numb after exercising for few minutes. There was no history of trauma and the patient had no constitutional symptoms. On physical examination, the right calf was non-tender with no mass although right posterior tibial and dorsalis pedis pulses were weaker than the left. Radiograph of the right knee showed static right proximal tibial exostosis, which had been monitored since the patient was aged 10 years. Magnetic resonance arteriogram showed almost complete occlusion of the right popliteal artery and distal superficial femoral artery at the level of the right popliteal fossa (Fig 1). Collateral branches were seen feeding the distal right leg arteries trifurcation. Magnetic resonance imaging scan of the knee revealed the medial head of the gastrocnemius inserting at a more lateral position than usual (Fig 2). The popliteal artery was separated from the popliteal vein, passing medial to and underneath the medial head of the gastrocnemius, and was severely compressed between the medial head of the gastrocnemius and distal femur. Loss of normal flow-related signal void was noted in the right popliteal artery distal to the compression.