Popliteal Vein Aneurysm: A Rare Cause of Pulmonary Emboli

Venous aneurysms are a rare pathology that was first reported in the literature in 1968. Popliteal venous aneurysms (PVAs) are the most common lower limb venous aneurysm and have significant consequences including deep vein thrombosis, pulmonary embolus (PE), and death. A 52-year-old woman presented with chest pain and shortness of breath. A computed tomography (CT) angiography demonstrated bilateral pulmonary emboli, and she was commenced on rivaroxaban. History revealed no significant risk factors, and a thrombophilia screen was negative. However, an aneurysmal popliteal vein as seen on an ultrasound scan that was further clarified with CT venography. She underwent an uncomplicated open tangential resection and lateral venorrhaphy. The diagnosis of PVA is usually made incidentally during investigations for pulmonary embolism or chronic venous insufficiency. Surgery is indicated in all symptomatic patients with PE as anticoagulation alone is inadequate in these patients. Surgery is also recommended in patients with asymptomatic saccular aneurysms or large (>20 mm) fusiform aneurysms. The current mainstay of treatment for PVAs is open surgical management.