0:00

This is another young patient undergoing a dedicated right

0:04

lower extremity artery angiogram.

0:08

We can see that there's not much atherosclerosis, and as we're going

0:12

down and looking at that popliteal artery, we suddenly see that there is

0:16

a narrowing of the popliteal artery.

0:19

On interrogating it further,

0:23

we can see that it looks like there's actually some hypodensity

0:26

along the wall of the

0:29

popliteal artery that is resulting in its compression.

0:34

And it can be hard to assess this because there is an adjacent vein

0:38

next to it, but I think it's undeniable that this structure is the vein, and

0:42

this structure is your artery with something in the wall of the artery.

0:45

Now, this structure appears to be hypodense, and it looks

0:50

cystic. It

0:52

has an attenuation of 23. If I overlay the delayed phase image,

0:56

and now you can see that popliteal vein enhancing a little bit better.

1:00

Knowing that this person doesn't have much atherosclerosis and is a young

1:03

person, the most common entity where you see a

1:08

lesion in the wall of an artery that causes compression, and we

1:11

just underwent an overview on the slide deck four, is cystic adventitial

1:15

disease.

1:17

One of the ways of managing this is actually just percutaneous drainage by

1:21

interventional radiologists, which is actually what this

1:24

person decided to opt for. Typically, MR

1:29

is the modality of choice because you would see a cystic structure, which is a

1:32

non-enhancing T2 hyperintense structure in the wall that's causing

1:36

varying degrees of stenosis of the popliteal artery, the most common

1:40

artery involved. This was pathologically

1:44

proven to be cystic adventitial disease.