Poster 137 Delayed Diagnosis of Popliteal Artery Entrapment Mistaken for Exertional Compartment Syndrome, Novel Use of MSK US to Improve Diagnostic Sensitivity: A Case Report

Igolnikov, Ilya; Santiago, Matthew J.; Gollotto, Kathryn T.

doi:10.1016/j.pmrj.2016.07.179

Cited by 1 publication

(2 citation statements)

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“…Multiple case reports have described individuals who were initially treated for CECS, often surgically, who experienced persistent or progressive symptoms, and were eventually diagnosed with PAES months to years after their initial presentation. 1,3,10,11 In a study by Turnipseed et al, 5 51% of patients diagnosed and surgically treated for PAES had undergone compartment release procedures before or after surgery for PAES. The same group also demonstrated that 23% to 30% of all patients treated for CECS at their institution had positive PAE studies.…”

Section: Discussionmentioning

confidence: 99%

“…There are case reports documenting the misdiagnosis of one entity for the other or the concurrent presence of both. [1][2][3][4] In addition, one group has demonstrated that a large proportion of those diagnosed with PAES were either also diagnosed with CECS or were previously treated for CECS. 5 Management of the 2 conditions differs and inadequate understanding of their relationship can result in missed diagnoses, insufficient treatment, unsatisfactory outcomes, repeat costly interventions, and slower return to sport.…”

Section: Introductionmentioning

confidence: 99%

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Radiological Prevalence of Popliteal Artery Entrapment in Individuals With Anterior Leg Compartment Chronic Exertional Compartment Syndrome

Johnson

Finnoff

Amrami

et al. 2020

Clinical Journal of Sport Medicine

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Objective:Determine the radiological prevalence of popliteal artery entrapment (PAE) in subjects with anterior leg compartment chronic exertional compartment syndrome (CECS).Design:Retrospective review.Setting:Tertiary care center.Patients:Of 71 patients diagnosed with anterior leg compartment CECS using an in-scanner exercise-based magnetic resonance imaging (MRI), 64 also completed Fast Imaging Employing Steady-State Acquisition (FIESTA) imaging.Interventions:Electronic health records of patients diagnosed with anterior leg compartment CECS using an in-scanner exercise-based MRI between 2009 and 2018 were reviewed.Main Outcome Measures:Demographics, symptom laterality, and results of vascular work-up.Results:Magnetic resonance imaging was positive for PAE in 33 of 64 (51.6%). Vascular evaluation was performed in 30 of 33 (90.9%). Of these 30, ankle-brachial indices (ABIs) with PAE maneuvers were performed in 29 (96.7%) and positive in 25 (86.2%). Pre-exercise and post-exercise ABIs were performed in 29 (96.7%) and abnormal in 20 (69.0%). Thirteen arterial duplex ultrasounds were performed; 10 were consistent with PAE (76.9%). An MR angiogram was performed in 8 (26.7%) and consistent with PAE in all. One computed tomography angiogram (3.3%) was completed and was normal. Overall, one or more tests were positive for PAE in all 30 with vascular evaluation.Conclusions:The radiological prevalence of PAE and anterior leg CECS was 51.6%. All subjects with vascular studies (90.9%) had one or more tests confirming radiological PAE. These findings suggest that the coexistence of PAE and CECS is common, and the PAE protocol used has a high correlation with vascular studies.

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