Cystic adventitial degeneration: Ectopic ganglia from adjacent joint capsules

Abstract

Cystic adventitial degeneration is a rare non-atherosclerotic cause of peripheral arterial occlusive disease, mainly seen in young men without other evidence of vascular disease. Diagnosis will be established by clinical findings and by ultrasound or angiography and can be treated by excision or enucleation of the affected arterial segment or by percutaneous ultrasound-guided aspiration. However, the etiology of adventitial cysts remains unknown. We report a case of cystic adventitial degeneration showing a connection between the joint capsule and the adventitial cyst, supporting the theory that cystic adventitial degeneration may represent ectopic ganglia from adjacent joint capsules.

Cystic Adventitial Disease of the Popliteal Artery: Report on Three Cases and Review of the Literature

“…This fact was important for postulating the first three theories. Moreover, the developmental and ganglionic concepts presume a joint-related origin of adventitial cysts and are supported by other findings: A communication between adventitial cyst(s) and an adjacent joint capsule was observed during surgery by some authors 5,8,11,22,[31][32][33][34] .The preoperative revelation of such a communication is also possible. A case of arthroscopic detection 35 and cases of MRA detection 31,36 have been documented.…”

“…In addition, it can exclude any other pathology in a differential diagnosis -the atherosclerotic disease, popliteal aneurysm, popliteal artery entrapment syndrome, popliteal, ganglion and parameniscal cysts, soft-tissue tumors. Cases of the preoperative finding of a communication between adventitial cysts and the adjacent joint on the MRA have been published 32,37 . However, in most of the CAD cases with revealed knee joint connection reported in the literature, the connection was too small to be revealed by imaging techniques, and it was observed only during surgery 16 .…”

“…Direct communication between the cyst and the knee joint is often demonstrated 64 , so temporary or even permanent relief from the symptoms can be explained by the drainage of the cyst content into the adjacent joint. Rupture is another possible mechanism of spontaneous CAD resolution 5,8,11,15,16,22,31,32,35,41,59 . In our second case, we observed changes in the size of the adventitial cyst despite constant problems perceived by the patient.…”

“…Other such cases involving remission during follow-up were also reported 81 , even after 10 years recurrence was excluded in a symptom-free patient, so the authors called this case a spontaneous and permanent CAD resolution 72 . The possible mechanisms of spontaneous cyst resolution may include cyst rupture 16,59 or drainage into the joint space, which is supported by the arthroscopic 35 , intraoperative 5,8,11,22,[31][32][33]41 or MRA (ref. 32,37 ) findings of a direct communication between the popliteal artery adventitial cyst and the knee joint.…”

“…The possible mechanisms of spontaneous cyst resolution may include cyst rupture 16,59 or drainage into the joint space, which is supported by the arthroscopic 35 , intraoperative 5,8,11,22,[31][32][33]41 or MRA (ref. 32,37 ) findings of a direct communication between the popliteal artery adventitial cyst and the knee joint. Despite the above-mentioned excellent results Holden et al 59 and Asciutto et al 15 emphasise that the relief is frequently only temporary, with the recurrence of the cysts and symptoms after a period ranging from a few days to several months.…”