PMC2647180_01
US of adventitial cystic disease in 69-year-old man.. A. US showed relationship between cystic mass and left common femoral vein. Cystic mass (*) that contained hypoechoic materials is attached to medial side of left common femoral vein (v).. B. Venous phase axial CT scan shows approximately 1.7 cm sized round, nonenhancing cystic mass (long arrow) compressing left common femoral vein with dilated medial circumflex femoral and obturator veins, which provide collateral circulation.. C. Coronal reconstruction image shows low attenuation nonenhancing mass (white arrow) in left common femoral vein.. D. Posterior view of three dimensional volume rendering image of left common femoral vein showing near complete obstruction of left common femoral vein (white arrow) with formation of multiple collateral vessels.. E. Photomicrograph of excised left common femoral vein. x40; Elastin Van Gieson stain reveals widening of adventitial layer of vein and replacement of elastic tissue by fibrous connective tissue (arrow), which is all consistent with cystic adventitial disease. Cyst was removed (asterisk).. F. Photomicrograph of excised left common femoral vein. x40; Hematoxylin & Eosin stain shows adventitial hemorrhage and fibrin deposition within widened adventitial layer of vein (arrow). * = cyst. G. Postoperative CT venography of patient's adventitial cystic disease. Lateral view of three dimensional volume rendering image showing that left common femoral vein (arrow) runs through previous cystic mass site and multiple collateral vessels have disappeared.
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Ultrasonography showed a cystic mass containing hypoechoic materials attached to the left common femoral vein (Fig. 1A). The axial and coronal reconstruction images showed a 1.7 cm sized cystic mass compressing the left common femoral vein along with dilated medial circumflex femoral and obturator veins that provided collateral circulation for the occluded left common femoral vein (Fig. 1B, C). A 3D volume rendering image showed an abrupt tapered disconnection of the left common femoral vein along with the formation of multiple collateral vessels (Fig. 1D). Microscopically, a cystic widened adventitial layer of the vein showed adventitial hemorrhage, fibrin deposition and focal aggregation of foamy histiocytes and focal myxoid degeneration (Fig. 1E, F). The cystic mass in the left inguinal areas was gone, as were the multiple collateral vessels (Fig. 1G).