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[A construction worker with acute knee pain]
Sven Ross Mathisen1, Alfred Arvesen, Andries Kroese
1Oslo Karkirurgiske Senter, Aker universitetssykehus, 0514 Oslo. svenross@online.no
Summary
Ruptured popliteal aneurysms are often misdiagnosed as deep venous thrombosis, delaying critical treatment. Prompt diagnosis with duplex scans is crucial to prevent limb loss.
Area of Science:
- Vascular Surgery
- Diagnostic Imaging
Background:
- Popliteal artery aneurysms account for 70% of peripheral arterial aneurysms.
- Ruptured popliteal aneurysms are rare (<4%) but can present with symptoms mimicking deep venous thrombosis.
Observation:
- Three patients admitted with suspected venous thrombosis were initially misdiagnosed.
- Delayed diagnosis occurred in 2, 18, and 20 days after symptom onset in the studied cases.
Findings:
- Hematoma from ruptured popliteal aneurysms can cause pain and swelling, leading to misdiagnosis as deep venous thrombosis or Baker's cyst.
- Warfarin anticoagulation was initiated in two patients before correct diagnosis and surgical intervention.
Implications:
- Early diagnosis of ruptured popliteal aneurysms is vital to avoid increased morbidity and potential limb loss.
- Duplex ultrasonography is recommended for accurate diagnosis.
- Surgical intervention, including aneurysm exclusion and bypass grafting, is mandatory for ruptured popliteal aneurysms.
