PMC7341352_01
Images of popliteal venous aneurysm. (A) Lower extremity ultrasound in the emergency room. The ultrasound revealed a popliteal venous aneurysm and spontaneous echo contrast (SEC) (arrow mark). There was no spontaneous echo contrast other than in the popliteal venous aneurysm. (B) Ultrasound imaging after treatment. The diameter of the popliteal vein, which had been aneurysmal, had decreased. (C) Plane computed tomography (CT) image before surgery showing a 20 mm diameter saccular popliteal venous aneurysm. SEC was observed on ultrasound, but there was no sign of thrombus on ultrasound imaging. (D) Unenhanced CT after treatment. The diameter was reduced to 11 mm, and SEC was not observed on ultrasound imaging, which suggests improved blood flow in the popliteal vein.
gr1.jpg
PMC7341352_01_gr1.jpg
fig1
Lower limb ultrasound revealed saccular dilatation of the left popliteal vein 20 mm in diameter, which was subsequently diagnosed as left PVA (Fig. 1A,C). The diameter was decreased to the same size as the proximal and distal popliteal veins (Fig. 1B,D). One week after surgery, left lower limb ultrasound showed no venous thrombus, and the SEC in the popliteal vein had also disappeared (Fig. 1B).
Pre- and post-operative images of pulmonary embolism. (A) Enhanced computed tomography (CT) scan in which thrombus was detected in peripheral pulmonary arteries (arrows). (B) Inferior vena cava (IVC) filter removed from the patient after treatment. Even though enhanced CT and IVC venography were performed, which ruled out major thrombus, minor thrombus was observed. This meant that the small thrombus was formed in and had travelled from the popliteal venous aneurysm.
gr2.jpg
PMC7341352_01_gr2.jpg
fig2
Enhanced pulmonary CT revealed peripheral PE (Fig. 2A). The filter was subsequently removed, and a small thrombus was observed on the filter fibres (Fig. 2B).
Images of operative findings. (A,B) Intra-operative images before aneurysmorrhaphy. A 20 mm saccular popliteal venous aneurysm was observed which was almost the same as in the pre-operative evaluations (arrow mark). (C) The aneurysm was incised after clamping. There was no evidence of thrombus, and the intima appeared normal on inspection, which justified aneurysmorrhaphy rather than grafting or interposing. (D) Imaging after completion of aneurysmorrhaphy (arrow mark: sutured line). The saccular aneurysm disappeared, and the diameter became the same as the proximal and distal veins.
gr3.jpg
PMC7341352_01_gr3.jpg
fig3
An "S" shaped skin incision was made in the popliteal space to expose the popliteal vein where a saccular PVA was seen (Fig. 3A and B). There was no thrombus, and the intima appeared normal on inspection (Fig. 3C). Two additional venorrhaphies were performed on both lateral walls of the PVA (Fig. 3D).