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Our next two and last two cases for this course are

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on popliteal artery or popliteal entrapment syndrome.

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And there can be different causes of this,

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but essentially it requires dynamic imaging.

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Now, because most of these patients come with a

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claudication, chances are if this wasn't high on the clinical

0:20

index before the scan, it wasn't appropriately

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protocoled to be acquired with dynamic imaging.

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But there can be subtle clues in your imaging that you might want to raise

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concern for entrapment syndrome.

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So if you see any stenosis in a patient who doesn't

0:37

have plaque and is young, you might want to consider raising

0:40

suspicion such that they undergo dynamic imaging.

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And that's what happened in this patient.

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So if you compare the arteries now on both the

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right and the left side,

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and as I'm scrolling through the popliteal arteries, and we can look at the

0:56

right and compare that to the left side.

1:00

And we're going to just compare the caliber of both these popliteal

1:03

arteries

1:05

as I'm scrolling down. You can see that there's

1:09

significant narrowing of this left popliteal artery

1:13

compared to that right popliteal artery.

1:16

And

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in the absence of plaque, the most common reason

1:21

why someone would have that would be popliteal artery entrapment syndrome,

1:25

and that is why we suggested that this person undergo dynamic

1:29

imaging to exonerate the presence of popliteal artery

1:33

entrapment syndrome. And now this imaging can be in the form of an ultrasound

1:37

or an ankle-brachial index, or most commonly an MR.

1:40

An MR is typically preferred because more common causes and types of

1:44

popliteal artery entrapment involve attachments of the gastrocnemius muscles

1:48

and aberrant muscle slips, and so

1:52

those are better resolved on an MR.

1:54

This patient did undergo a follow-up MR with the dynamic imaging,

1:58

and on the slide deck that you will notice, the associated slide deck,

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there's a follow-up MRI that shows the dynamic

2:06

change in the caliber of the popliteal artery in plantar flexion

2:10

compared to neutral position.