Vascular Abnormalities in Athletes: State-of-the-Art Multimodality Imaging

Vascular abnormalities in athletes, although less common than musculoskeletal injuries, present a significant diagnostic challenge due to overlapping manifestations. These conditions range from subtle exertional discomfort to potentially limb-threatening ischemia and life-threatening complications such as pulmonary embolism or sudden cardiac death. In this comprehensive review, the authors highlight the spectrum of vascular abnormalities encountered in athletes, emphasizing the pivotal role of multimodality imaging, including US, CT angiography, MR angiography, and conventional angiography in their accurate diagnosis and effective management. They discuss upper extremity conditions such as Paget-Schroetter syndrome, quadrilateral space syndrome, palmar arch injury, and digital ischemia. Lower extremity conditions discussed include arterial thromboembolism, external iliac artery endofibrosis and dissection, adductor canal syndrome, chronic exertional compartment syndrome, popliteal entrapment syndromes, venous insufficiency, and cystic adventitial disease. Other conditions discussed include venous thromboembolism, median arcuate ligament compression, aortopathies, pulmonary hypertension, Bezold-Jarisch reflex, coronary artery disease, coronary anomalies, and high-flow priapism. The authors aim to equip radiologists with essential knowledge to promptly recognize these conditions, thereby facilitating early intervention and improved outcomes. ^©RSNA, 2026 Supplemental material is available for this article. See the invited commentary by Nagpal and Bluemke in this issue.