Laboratory workup included blood count, metabolic panel, thyroid studies, vitamin B12, Folate, and a complete rheumatological panel. All were normal.
Ankle-Brachial index was normal. EMG testing was normal. Vascular ultrasound examination of the leg showed no thrombosis. Bilateral compartment testing showed elevated anterior compartment pressures. Bilateral fasciotomy was performed. This did not resolve the symptoms and the patient next underwent an exercise arterial ultrasound that showed increased resistance with ankle dorsiflexion consistent with popliteal artery entrapment. MRI of the leg showed numerous multi-lobulated cystic lesions involving the popliteal artery suggesting a diagnosis of cystic adventitial disease. Case Photo #1, Case Photo #2
A vascular surgeon was consulted in the workup of this patient as well as for performing the fasciotomies and a popliteal artery resection.
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