The case
A 38 year male was referred to the Emergency Dept by his GP with a 4 day history of pain and swelling in his left leg as a possible DVT. On examination he had a tender, erythematous left calf which measured 43cm compared to 39cm on the right. Examination also revealed a strong popliteal pulse on the left side when compared to the right, all other pulses in the left leg where present.
There are lots of things that could cause this presentation but from an EM point of view we should consider:
- DVT
- Arterial vascular issues
Well this is an ultrasound blog so… yes you guessed it – apply the probe of knowledge!
This is a 5.5cm popliteal aneurysm with 3cm of organised thrombus
He went on to have CTA below showing a large popliteal aneurysm in the left leg.
The patient subsequently underwent great saphenous vein bypass of the aneurysm and his vascular status has remained stable since.
Popliteal aneurysm is an uncommon vascular disorder which can cause major complications if left untreated which include thrombosis, distal embolisation and occasionally rupture. It can present with acute limb ishcaemia as a result of the above.
This case represents a patient with a common presenting complaint where the use of simple bedside ultrasound available in most Emergency Departments was enough to suggest the presence of a much rarer condition.