Limits...
A new diagnostic approach to popliteal artery entrapment syndrome.

Williams C, Kennedy D, Bastian-Jordan M, Hislop M, Cramp B, Dhupelia S - J Med Radiat Sci (2015)

Bottom Line: A new method of diagnosing and defining functional popliteal artery entrapment syndrome is described.By combining ultrasonography and magnetic resonance imaging techniques with dynamic plantarflexion of the ankle against resistance, functional entrapment can be demonstrated and the location of the arterial occlusion identified.This combination of imaging modalities will also define muscular anatomy for guiding intervention such as surgery or Botox injection.

View Article: PubMed Central - PubMed

Affiliation: Queensland X-Ray Sunnybank, Queensland, 4109, Australia.

ABSTRACT
A new method of diagnosing and defining functional popliteal artery entrapment syndrome is described. By combining ultrasonography and magnetic resonance imaging techniques with dynamic plantarflexion of the ankle against resistance, functional entrapment can be demonstrated and the location of the arterial occlusion identified. This combination of imaging modalities will also define muscular anatomy for guiding intervention such as surgery or Botox injection.

No MeSH data available.


Related in: MedlinePlus

19-year-old female with popliteal artery entrapment syndrome (PAES). (A) Two colour Doppler ultrasound images with a linear 12 MHz probe in the transverse position at the level of the knee crease with the patient prone. The image on the left demonstrates normal popliteal arterial and venous colour flow in the rest position. The image on the right taken in the same position with the foot in plantar flexion against no resistance, demonstrates complete obliteration of popliteal arterial and venous flow between the medial and lateral heads of gastrocnemeii. (B) Axial T1 magnetic resonance imaging (MRI) defining anatomy surrounding popliteal artery at the level of occlusion demonstrated on the previous ultrasound images. Medial head of gastrocnemius shown in blue, lateral head of gastrocnemius shown in yellow and popliteal artery (arrow). The medial head of gastrocnemeii are lateral displaced resulting in crowding of the popliteal fossae and lateral displacement of the popliteal arteries. (C) Axial T2 steady state MRI images at rest (superiorly) and with non-resisted plantar flexion (inferiorly) demonstrating occlusion of popliteal arteries bilaterally. Arrows indicate location of popliteal arteries. (D) 3D coronal maximum intensity projection (MIP) reconstruction of MR angiogram performed in plantar flexion. Occlusion visualised bilaterally by lateral and medial heads of gastrocnemius, and on left by the plantaris muscles. Arrows indicate locations of occlusions.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4592677&req=5

fig01: 19-year-old female with popliteal artery entrapment syndrome (PAES). (A) Two colour Doppler ultrasound images with a linear 12 MHz probe in the transverse position at the level of the knee crease with the patient prone. The image on the left demonstrates normal popliteal arterial and venous colour flow in the rest position. The image on the right taken in the same position with the foot in plantar flexion against no resistance, demonstrates complete obliteration of popliteal arterial and venous flow between the medial and lateral heads of gastrocnemeii. (B) Axial T1 magnetic resonance imaging (MRI) defining anatomy surrounding popliteal artery at the level of occlusion demonstrated on the previous ultrasound images. Medial head of gastrocnemius shown in blue, lateral head of gastrocnemius shown in yellow and popliteal artery (arrow). The medial head of gastrocnemeii are lateral displaced resulting in crowding of the popliteal fossae and lateral displacement of the popliteal arteries. (C) Axial T2 steady state MRI images at rest (superiorly) and with non-resisted plantar flexion (inferiorly) demonstrating occlusion of popliteal arteries bilaterally. Arrows indicate location of popliteal arteries. (D) 3D coronal maximum intensity projection (MIP) reconstruction of MR angiogram performed in plantar flexion. Occlusion visualised bilaterally by lateral and medial heads of gastrocnemius, and on left by the plantaris muscles. Arrows indicate locations of occlusions.

Mentions: The following images in Figure1 are taken from a young female patient with a clinical history suspicious for PAES. This 19-year-old female hockey player that presented with several years of exertional left calf pain that had deteriorated over the last 6 months. She complained of slow onset cramping pain in the left calf with exercise and intermittent numbness in the left foot. She reported slow onset of symptoms when exercising on a flat surface however, climbing stairs was provocative. The pain can resolve with rest or persist for several hours after exercise. There were no symptoms in the right leg. Clinically the compartments of the calf were soft with no crepitus. The hop test was negative for a stress fracture or shin splints.


A new diagnostic approach to popliteal artery entrapment syndrome.

Williams C, Kennedy D, Bastian-Jordan M, Hislop M, Cramp B, Dhupelia S - J Med Radiat Sci (2015)

19-year-old female with popliteal artery entrapment syndrome (PAES). (A) Two colour Doppler ultrasound images with a linear 12 MHz probe in the transverse position at the level of the knee crease with the patient prone. The image on the left demonstrates normal popliteal arterial and venous colour flow in the rest position. The image on the right taken in the same position with the foot in plantar flexion against no resistance, demonstrates complete obliteration of popliteal arterial and venous flow between the medial and lateral heads of gastrocnemeii. (B) Axial T1 magnetic resonance imaging (MRI) defining anatomy surrounding popliteal artery at the level of occlusion demonstrated on the previous ultrasound images. Medial head of gastrocnemius shown in blue, lateral head of gastrocnemius shown in yellow and popliteal artery (arrow). The medial head of gastrocnemeii are lateral displaced resulting in crowding of the popliteal fossae and lateral displacement of the popliteal arteries. (C) Axial T2 steady state MRI images at rest (superiorly) and with non-resisted plantar flexion (inferiorly) demonstrating occlusion of popliteal arteries bilaterally. Arrows indicate location of popliteal arteries. (D) 3D coronal maximum intensity projection (MIP) reconstruction of MR angiogram performed in plantar flexion. Occlusion visualised bilaterally by lateral and medial heads of gastrocnemius, and on left by the plantaris muscles. Arrows indicate locations of occlusions.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4592677&req=5

fig01: 19-year-old female with popliteal artery entrapment syndrome (PAES). (A) Two colour Doppler ultrasound images with a linear 12 MHz probe in the transverse position at the level of the knee crease with the patient prone. The image on the left demonstrates normal popliteal arterial and venous colour flow in the rest position. The image on the right taken in the same position with the foot in plantar flexion against no resistance, demonstrates complete obliteration of popliteal arterial and venous flow between the medial and lateral heads of gastrocnemeii. (B) Axial T1 magnetic resonance imaging (MRI) defining anatomy surrounding popliteal artery at the level of occlusion demonstrated on the previous ultrasound images. Medial head of gastrocnemius shown in blue, lateral head of gastrocnemius shown in yellow and popliteal artery (arrow). The medial head of gastrocnemeii are lateral displaced resulting in crowding of the popliteal fossae and lateral displacement of the popliteal arteries. (C) Axial T2 steady state MRI images at rest (superiorly) and with non-resisted plantar flexion (inferiorly) demonstrating occlusion of popliteal arteries bilaterally. Arrows indicate location of popliteal arteries. (D) 3D coronal maximum intensity projection (MIP) reconstruction of MR angiogram performed in plantar flexion. Occlusion visualised bilaterally by lateral and medial heads of gastrocnemius, and on left by the plantaris muscles. Arrows indicate locations of occlusions.
Mentions: The following images in Figure1 are taken from a young female patient with a clinical history suspicious for PAES. This 19-year-old female hockey player that presented with several years of exertional left calf pain that had deteriorated over the last 6 months. She complained of slow onset cramping pain in the left calf with exercise and intermittent numbness in the left foot. She reported slow onset of symptoms when exercising on a flat surface however, climbing stairs was provocative. The pain can resolve with rest or persist for several hours after exercise. There were no symptoms in the right leg. Clinically the compartments of the calf were soft with no crepitus. The hop test was negative for a stress fracture or shin splints.

Bottom Line: A new method of diagnosing and defining functional popliteal artery entrapment syndrome is described.By combining ultrasonography and magnetic resonance imaging techniques with dynamic plantarflexion of the ankle against resistance, functional entrapment can be demonstrated and the location of the arterial occlusion identified.This combination of imaging modalities will also define muscular anatomy for guiding intervention such as surgery or Botox injection.

View Article: PubMed Central - PubMed

Affiliation: Queensland X-Ray Sunnybank, Queensland, 4109, Australia.

ABSTRACT
A new method of diagnosing and defining functional popliteal artery entrapment syndrome is described. By combining ultrasonography and magnetic resonance imaging techniques with dynamic plantarflexion of the ankle against resistance, functional entrapment can be demonstrated and the location of the arterial occlusion identified. This combination of imaging modalities will also define muscular anatomy for guiding intervention such as surgery or Botox injection.

No MeSH data available.


Related in: MedlinePlus