Acute Right Lower Extremity Swelling In A 61 Year Old Male
Joedd Biggs, MD, Manju Kalra, Randall R. DeMartino
Mayo Clinic, Rochester, MN
Demographics:61 year old Caucasian male History:He initially presented with nine days of right lower extremity swelling following a plane ride. Duplex ultrasound and computed tomography venogram (CTV) demonstrated adventitial cystic disease causing compression of his right common femoral vein without evidence of venous thrombosis. He sought a second opinion after a recommendation for surgical intervention locally. Following a long car ride, he noticed worsened swelling involving the thigh and was evaluated in the emergency room. Repeat ultrasound confirmed the cystic mass and demonstrated an acute DVT of the right common femoral vein and saphenous vein. He had no personal or familial history of thrombotic events. On examination, the patient had palpable pedal pulses and right lower extremity edema from the ankle to the thigh without varicosities or skin change.
Plan: The patient was initiated on anticoagulation and thigh-high elastic compression therapy. Repeat ultrasound at 6 months demonstrated recanalization of the common femoral and saphenous veins with chronic post thrombotic change. Magnetic resonance venogram demonstrated a 3 cm cyst anteromedial to the right common femoral vein compressing the lumen and another 1.2 cm cyst posterior to the vein communicating to the hip joint. The patient underwent open right femoral vein cyst excision with excision of the additional posterior cyst and ligation of a tubular structure traversing toward the joint. Intraoperative ultrasound confirmed normal caliber of the common femoral vein without compression.
Discussion:Venous adventitial cysts are rare, however their etiology is likely similar to arterial lesions. The MRI and intraoperative findings of this case support the synovial origin theory for adventitial cystic disease, even when involving the venous system.
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