Aneurisma poplíteo izquierdo / Left popliteal aneurysm

El aneurisma de la arteria poplítea es el principal aneurisma periférico y el segundo en frecuencia después del aneurisma de la aorta abdominal. Su incidencia se desconoce. Posee un patrón característico de presentación que corresponde a personas del sexo masculinos, mayores de 65 años, con múltiples comorbilidades, donde la hipertensión arterial representa la más frecuente. La definición de aneurisma corresponde a una dilatación del 50 por ciento del diámetro del vaso, en el caso de la arteria poplítea, mayor de 1,5 cm. El 50 por ciento de los aneurismas poplíteos resulta asintomático, el resto presenta síntomas isquémicos (trombosis, embolismos periféricos), compresivos y la ruptura. El tratamiento es quirúrgico: convencional (vías medial-posterior) y endovascular. El objetivo del artículo fue presentar este caso por la infrecuencia del aneurisma de la arteria poplítea unilateral. Se trata de un paciente masculino de 62 años, con aumento de volumen localizado a nivel de la fosa poplítea izquierda con latido y expansión a la palpación, diámetro transversal aproximado de 3 cm y longitudinal de 4 cm, presencia de soplo sistólico a la auscultación con diagnóstico ecográfico y arteriográfico de aneurisma de la arteria poplítea izquierda. La evolución del paciente fue satisfactoria y se mantiene bajo seguimiento médico para evaluar la permeabilidad del injerto sintético(AU)

Popliteal artery aneurysm is the main peripheral aneurysm and the second in frequency after abdominal aortic aneurysm. Its incidence is unknown. It has a characteristic presentation pattern that corresponds to male people, over 65 years of age, with multiple comorbidities, where arterial hypertension represents the most frequent. The definition of aneurysm corresponds to a dilation of 50 percent of the diameter of the vessel, in the case of the popliteal artery, greater than 1.5 cm. 50 percent of popliteal aneurysms are asymptomatic, the rest have ischemic symptoms (thrombosis, peripheral embolisms), compression and rupture. Treatment is surgical: conventional (medial-posterior pathways) and endovascular. The objective of the article was to present this case due to the infrequency of the unilateral popliteal artery aneurysm. This is a 62-year-old male patient, with localized volume increase at the level of the left popliteal fossa with heartbeat and expansion on palpation, approximate transverse diameter of 3 cm and longitudinal diameter of 4 cm, presence of systolic murmur at auscultation with ultrasound and arteriographic diagnosis of aneurysm of the left popliteal artery. The patient's evolution was satisfactory and he remains under medical follow-up to evaluate the permeability of the synthetic graft(AU)

MR examination plan of normal peroneal nerve and branches in popliteal fossa / 中国医学影像技术

Objective：To explore MR examination scheme for common peroneal nerve and its branches in the popliteal fossa. Methods： Oblique coronal improved fast spin echo (FSE-XL) T1W, FSE-XL T2W, FSE-XL T2W+iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL), short time inversion recovery (STIR) and sagittal three-dimensional fast spoiled gradient-recall echo (3D FSPGR)+IDEAL scanning were performed on 30 popliteal fossa of 30 volunteers. CNR of the peroneal nerve/femoral muscles in oblique coronal images of different sequences were calculated and compared. The displaying scores of the common peroneal nerve and its branches in oblique coronal images, of sagittal 3D FSPGR+IDEAL on common peroneal nerve and its branches were all analyzed. Results ：The overall differences of CNR in the oblique coronal FSE-XL T1W, FSE-XL T2W, STIR, FSE-XL T2W+IDEAL had statistical significance (F=123.57, P<0.01), of CNR between FSE-XL T1W, FSE-XL T2W and STIR, FSE-XL T2W+IDEA were also statistical significance (all P<0.01). There was no significant difference in overall scores of common peroneal nerve (χ2=0.077, P=0.942) among FSE-XL T1W, FSE-XL T2W, STIR and FSE-XL T2W+IDEAL, while the overall differences of the scores of lateral peroneal cutaneous nerve, deep peroneal nerve and superficial peroneal nerve among the 4 sequence images were statistical significance (all P<0.05), FSE-XL T2W+IDEAL and STIR sequence images showed statistical significance differences of lateral peroneal cutaneous nerve, the deep peroneal nerve and superficial peroneal nerve (all P<0.05). The displaying rate of 3D FSPGR+IDEAL imaging for common peroneal nerve and its branch were all 100%. Conclusion： MRI can well display common peroneal nerve and its branches in the popliteal fossa with recommended FSE-XL T2W+IDEAL and sagittal 3D FSPGR+IDEAL sequences.

Clinical importance of tensor fasciae suralis arising from linea aspera along with short head of biceps femoris: a rare anomaly / 대한해부학회지

Tensor fasciae suralis, also known as ischioaponeuroticus is a clinically relevant muscle variant located in the popliteal fossa. Though rare, when present the muscle may arise from any of the hamstrings and gets inserted to the crural fascia of leg or tendocalcaneus and is innervated by the tibial component of sciatic nerve. Here we report a variant of tensor fasciae suralis originated from the lowermost part of linea aspera along with the fibers of short head of biceps femoris in the left lower limb of a male cadaver aged approximately 58 years. The muscle was 16 cm in length and 1 cm breadth in its widest part. It was found inserted to the crural fascia over the lateral head of gastrocnemius and was found innervated by common peroneal nerve. To the best of our knowledge, the tensor fascia suralis muscle originated from linea aspera along with short head of biceps femoris and innervated by common peroneal nerve has not been reported in either cadaveric or imaging studies.

Neurovascular Compression Caused by Popliteus Muscle Enlargement Without Discrete Trauma

Popliteal entrapment syndrome caused by isolated popliteus muscle enlargement is very rare, although its occurrence has been reported after discrete trauma. However, popliteal artery stenosis with combined peroneal and proximal tibial neuropathy caused by popliteus muscle enlargement without preceding trauma has not been reported. A 57-year-old man presented with a tingling sensation and pain in his left calf. He had no previous history of an injury. The symptoms were similar to those of lumbosacral radiculopathy. Calf pain became worse despite treatment, and the inability to flex his toes progressed. Computed tomography angiography and magnetic resonance imaging of the lower extremity showed popliteal artery stenosis caused by popliteus muscle enlargement and surrounding edema. An electrodiagnostic study confirmed combined peroneal and proximal tibial neuropathy at the popliteal fossa. Urgent surgical decompression was performed because of the progressive neurologic deficit and increasing neuropathic pain. The calf pain disappeared immediately after surgery, and he was discharged after the neurologic functions improved.

Neurovascular Compression Caused by Popliteus Muscle Enlargement Without Discrete Trauma

Popliteal entrapment syndrome caused by isolated popliteus muscle enlargement is very rare, although its occurrence has been reported after discrete trauma. However, popliteal artery stenosis with combined peroneal and proximal tibial neuropathy caused by popliteus muscle enlargement without preceding trauma has not been reported. A 57-year-old man presented with a tingling sensation and pain in his left calf. He had no previous history of an injury. The symptoms were similar to those of lumbosacral radiculopathy. Calf pain became worse despite treatment, and the inability to flex his toes progressed. Computed tomography angiography and magnetic resonance imaging of the lower extremity showed popliteal artery stenosis caused by popliteus muscle enlargement and surrounding edema. An electrodiagnostic study confirmed combined peroneal and proximal tibial neuropathy at the popliteal fossa. Urgent surgical decompression was performed because of the progressive neurologic deficit and increasing neuropathic pain. The calf pain disappeared immediately after surgery, and he was discharged after the neurologic functions improved.

Posterior Knee Pain: An Unusual Cause.

The pain around the posterior knee called ‘popliteal fossa’ has been known to be caused by a variety of disease entities. Whatever the causes, the challenge remains in diagnosis. Proper history and clinical examination followed by uses of appropriate diagnostic tools are secrets to success. Venous malformation is a very rare cause of pain in popliteal area and its diagnosis is frequently delayed, missed or given incorrectly. Here, we report a case of a 24-year-old patient who presented with posterior knee pain for 2 years and was diagnosed as a case of intramuscular arterio-venous malformation by lower limb angiography. This patient was treated successfully by surgical resection. His follow-up was satisfactory with no evidence of recurrence.

Bilateral Anomalous Muscle In the Popliteal Fossa & Its Clinical Significance.

Muscle variation may occur due to genetic or developmental causes. Some variations may compromise the vascular, muscular or nervous system in the region. Bilateral muscle variation in popliteal fossa is very rare. In present study an instance of bilateral muscle variation in popliteal fossa, arising from different muscles like gastrocnemius and from biceps femoris is recorded. There is no report of such variations. These observations are rare of its kind because of bilateral asymmetrical presence and difference in the origins in different legs. This is the first report as for the literatures available. Clinical and functional importance of such variation is discussed with the morphological aspects of this anomalous muscle.

Direct popliteal artery perforator flap: anatomical study and clinical application / 中华显微外科杂志

Objective To investigate and evaluate the clinical effect of the direct popliteal artery perforator flap.Methods Thirty embalmed lower limbs of adult cadavers which perfused with red latex were used to dissection,major observations were the origin,perforators and anastomoses regulations of the direct popliteal artery.Based on the anatomical study,direct popliteal artery perforator flaps were designed and used clinically to 7 patients who had soft tissue defects in popliteal fossa.Results The direct popliteal artery perforator was direct started from lateral wall of the superior segment of popliteal artery,and about 7-11 cm above knee joint.Then it goes up along the middle line of posterior region of thigh,and pierced from the carvity between semitendinosus and biceps femoris and gave off several branches in superficial fascia.Finally,these branches anastomoses with many perforating branches which were gave off form deep femoral artery (the 1st to 3rd perforator artery),obturator artery and lateral circumflex femoral artery.Clinically,all flaps were survived eventually,and 6 of them were healed quickly,only 1 case needed to change dressings to healed its partial necrosis for the pedicle had too much soft tissues and too swelling to block its blood supply.After 2-12 months of following-up,the colors and appearances of these flaps were excellent,and the function of knees were nearly normal.Conclusion Direct popliteal artery perforator flap has relatively constant location and sufficient blood supply to use in clinical application,it is safe and easy to use for recovering soft tissue defects in popliteal fossa.

A cadaveric study about the localization of sciatic nerve separation point in Thais: Implications for nerve block.

Objectives: The aim of this study was to evaluate the distance of the separation point of sciatic nerve in popliteal fossa and its relation to the length of femur in Thai cadavers. Method: One hundred and six Thai cadavers which composed of 105 right legs and 106 left legs were examined in this study. After dissection of the popliteal fossa, the distance of the separation point of the sciatic nerve above the level of both femoral epicondyles was measured in 84 right legs and 89 left legs of 66 male and 40 female cadavers. In addition the length of femur, which was the distance from posterior edge of the greater trochanter to the most prominent point of lateral epicondyles, was recorded. Results: In the specimen of this study, the sciatic nerves separated at a mean distance of 8.72 + 4.35 cm and 7.32 + 3.03 cm above the level of both femoral epicondyles in male and female cadavers with the highly variation range from 2.1 to 30.7 cm. The mean distances of the right and left legs in male cadavers were 8.49 + 4.39 and 8.90 + 4.32 cm respectively, being longer than in female cadavers (7.32 + 3.67 and 7.28 + 2.30 cm respectively) There were no significant differences in both the distance of the separation point and the length of femur by sex or side. Conclusion: The distances of the separation point of the sciatic nerve above the level of both epicondyles in Thai cadavers were highly variable and not related with the length of the femur.

Popliteal Fossa Pain in 24 Year-old Female

The pain around the posterior knee, called 'popliteal fossa', has been known to be caused by a variety of disease entities. Venous malformation is a very rare cause of popliteal area pain, and its diagnosis is frequently delayed, missed, or given incorrectly. Here, we report a case of a patient with popliteal fossa pain for 2 years and was diagnosed as intramuscular venous malformation using ultrasound.

Atypical Varicose Veins in the Popliteal Fossa Unrelated to Small Saphenous Vein Reflux

PURPOSE: To analyze the causes, clinical features, and computed tomography (CT) images of atypical varicose veins in the popliteal fossa unrelated to small saphenous vein (SSV) reflux by three-dimensional CT venography (3D-CTV). METHODS: A total of 1,476 limbs in 794 consecutive patients with varicose veins who underwent surgery from 2005 to 2009 were enrolled. The medical records, duplex ultrasound, and 3D-CTV images were analyzed retrospectively. RESULTS: Varicose veins in the popliteal fossa (PFV) were found in 438 of 1,476 limbs; the PFV in 428 limbs (97.5%) were caused by SSV insufficiency. Ten limbs (2.5%) had atypical PFV unrelated to the SSV. Incompetent perforator of the PPF was found in six of ten limbs (four women and two men; median age, 58-years). The CEAP clinical classes were C2 in four limbs and C4 in two limbs. The PPF drained to the popliteal vein in five limbs and to the gastrocnemial vein in one limb. A perforator ligation was performed in all patients, and additional sclerotherapy was performed in one patient. Thigh or calf perforator insufficiency was found in three limbs (two women and one man; median age, 62.7-years). The CEAP clinical classes were C2 in two limbs and C3 in one limb. Great saphenous vein insufficiency with Giacomini vein reflux was found in one limb (woman, 67-years). CONCLUSION: An exact preoperative understanding of the anatomy and flow dynamics is essential for the proper treatment of rare atypical PFV. A preoperative evaluation with 3D-CTV can provide accurate anatomical information for the surgery.

Intraneural Ganglion of the Tibial Nerve in the Popliteal Fossa: A Case Report

Intraneural ganglion is a relatively rare clinical entity that is commonly found in the peripheral nerves in the upper and lower extremities. It is commonly manifested by motor deficits, pain and sensory changes due to nerve entrapment and compression of the involved nerve. An intraneural ganglion of the tibial nerve is very rare. We present here a rare case of intraneural ganglion of the tibial nerve in the popliteal fossa and the patient had a neurologic deficit, and this was all treated successfully. We review the clinical course of the patient and the relevant issues are discussed together with a thorough review of the relevant literature.

Popliteal Lymph Node Dissection in Lower Extremity Malignant Melanoma

PURPOSE: Malignant melanoma of the lower extremity is well known to metastasize to the lymph nodes of the groin. However, in rare cases, the initial site of the nodal disease can be the popliteal fossa. As of yet, there has not been any report on cases with popliteal lymph node metastasis in Koreans. In the following report, authors would like to present two cases of popliteal node metastasis. METHODS: A 60-year-old male patient presented with nodular mass in his left sole. He had popliteal node metastasis detected on preoperative positron emission tomography(PET). Another 67-year-old man presented with pigmented lesion in his right heel. He also had popliteal node metastasis detected on the MRI. They underwent wide excision of the primary lesion with popliteal node dissection. RESULTS: In the first case, 2.5x2.5cm sized metastatic melanoma in popliteal node was pathologically confirmed. There were no postoperative complications, and to date (18 months after the surgery), the patient is alive with no evidence of disease. In the second case, multiple(4) metastatic melanoma in popliteal nodes was confirmed. The patient is alive, but has had interferon therapy for liver metastasis. CONCLUSION: By increasing the use of lymphoscintigraphy or PET as a preoperative diagnostic work-up for metastasis, even popliteal node metastasis undetectable in a physical exam becomes detectable. When metastatic lymph node is found, node dissection is the standard of care. Therefore, it is essential that we know the anatomy and surgical technique for popliteal lymph node dissection.