Pulmonary Embolism Caused by Popliteal Venous Aneurysm
A previously healthy 44-year-old man was admitted for shortness of breath that had developed 1 day earlier. He denied having any chest pain or hemoptysis. There was no calf tenderness suggesting deep vein thrombosis or a palpable lower extremity mass. His previous medical history was remarkable for bilateral pulmonary thromboembolism, which had occurred about a month prior, for which he was treated with tissue plasminogen activator, heparin, and warfarin. His initial work-up including vital signs, physical examination, chest X-ray, and electrocardiogram were unremarkable except for a marginal oxygen saturation level of 90%. Based on his previous history of pulmonary thromboembolism, a pulmonary computed tomography (CT) angiogram was performed, which revealed bilateral multifocal filling defects in the pulmonary arteries, but showed a relatively preserved distal flow, and was absent of any parenchymal lung lesions. He was initially admitted to the cardiology department and received anticoagulation therapy. To investigate the possible underlying medical causes, a lower extremity CT angiogram was performed two days later, which revealed a huge thrombus-filled venous aneurysm (6×11 cm in size) of the left popliteal vein (). A lower extremity (vein) Doppler sonography was performed the next day, which showed a huge wide-necked venous aneurysm (5×3×10 cm in size) with a floating pedunculated thrombotic mass within the lateral aspect of the popliteal vein lumen (). Aneurysmectomy and saphenous vein interposition were performed to prevent a recurrence of pulmonary embolism on the posterior approach via an S-shaped incision to the popliteal fossa (). The opened aneurysmal sac was filled with a huge pedunculated fresh thrombus, which could be easily embolized to the pulmonary vessels. After the operation, heparin and warfarin were administered. The patient has been asymptomatic for 2 years with no remarkable complaints or signs of pulmonary embolism or lower extremity thrombosis ().