A rare presentation of ruptured infected popliteal artery aneurysm with massive local emphysema

Abstract

A 60-year-old male was admitted to our department due to a painful right lower limb, associated with pulsatile edema from the mid-thigh to proximal leg, fever and rapid clinical deterioration. He had had a recent hospitalization due to diarrhea, which improved after hydration and intravenous empirical antibiotic therapy. His medical history was notable for chronic heart failure, hypertension, smoking, hypercholesterolemia, and diabetes mellitus type 2, which was poorly controlled. Duplex ultrasonography showed arterial dilatation above and below the right knee. A computed tomography (CT) angiography scan displayed a ruptured popliteal aneurysm (Panel A, arrow) with extravasation into the soft tissues and massive local emphysema (Panels A and B) within the right popliteal fossa and distal femur (Panel C, arrowhead). The maximum diameter was 2.7 cm. The 3D reconstruction identified the exact point of rupture with plaque disruption (Panel D, arrow). The patient underwent a surgical procedure where the distal superficial femoral artery was ligated, the aneurysm was excluded and the affected artery resected. Blood flow was restored through an internal saphenous vein bypass. The patient died due to acute myocardial infarction on the eighth postoperative day. Blood culture was positive for