Summary: A 49 year-old nonsmoking male presents after eight months of
progressive right lower extremity claudication and paresthesias. MRA, MRI, and
eventually catheter angiography of the lower extremity were obtained.
Cystic adventitial disease
MRA demonstrates smooth short segment narrowing of the
popliteal artery (Figure 1). MRI of the right knee reveals focal extrinsic
compression of this segment by a multiloculated T2 hyperintense cystic lesion (Figure
2A, 2B). Angiography for treatment
planning purposes redemonstrates “hourglass” narrowing of the popliteal artery
Cystic adventitial disease is a relatively rare cause of
claudication. 1 However, it should be considered in the differential
diagnosis, particularly in a nonsmoking, middle-aged man with progressive
symptoms. The distribution is most
commonly unilateral, affecting the popliteal artery in the majority of cases. 2
External iliac, common femoral, radial, and ulnar arteries are less
commonly affected. 2,3
Angiography will demonstrate a smooth short segment stenosis.
Circumferential disease produces a classic "hourglass" narrowing of
the vessel when disease is circumferential whereas eccentric disease results in
a “scimitar” appearance of the vessel. MRI reveals the causative lesion,
typically T2 hyperintense cystic structures surrounding and narrowing the
artery. T1 signal is variable and depends on the composition of cystic
The disease tends to be progressive when untreated. Ultrasound-guided
percutaneous aspiration has been shown to be safe and efficacious 4 and may
be used as a temporizing measure in cases of incomplete occlusion. Definitely treatment relies on excision of
cysts and artery followed by reconstruction with autologous vein. Endovascular
treatments thus far have had disappointing results. 5,6
- Elias DA, White LM, Rubenstein JD, Christakis M, Merchant
N. Clinical evaluation of MR imaging features of popliteal artery entrapment
and cystic adventitial disease: pictoral essay. AJR 2003;180:627-632.
- . Flanigan DP, Burnham SJ, Goodreau JJ, Bergan JJ: Summary
of cases of adventitial cystic disease of the popliteal artery. Ann Surg.
- Peterson JJ,
Kransdorf MJ, Bancroft LW, Murphey MD. Imaging characteristics of cystic
adventitial disease of the peripheral arteries: presentation as soft tissue masses. AJR 2003;180(3):621-5.
- Do DD, Braunschweig M, Baumgartner I, Furrer M, Mahler F.
Adventitial cystic disease of the popliteal artery: percutaneous US-guided
aspiration. Radiology. 1997;203:743–746.
- Fox R, Kahn M, Adler J, et al. Adventitial cystic disease
of the popliteal artery: failure of percutaneous transluminal angioplasty as a
therapeutic modality. J Vasc Surg. 1985;2(3):464-467.
- Khoury M. Failed angioplasty of a popliteal artery
stenosis secondary to cystic adventitial disease. Vasc Endovascular Surg. 2004;38(3)277-280.