Popliteal artery aneurysms masquerading as deep vein thrombosis

Abstract

A 77 year old man with known ischaemic heart disease and p paroxysmal a trial fibrillation treated with a spirin and amiodarone, presented with progressive painful swelling of his left leg. He was also known to have a 5cm abdominal aortic aneurysm, which was under surveillance. On examination, he was tachycardic and pyrexial with a tender, swollen, erythenratous left leg. A deep venous thrombosis with overlying cellulitis was diagnosed and he was commenced on intra-venous antibiotics and therapeutic doses of subcutaneous Heparin. Blood cultures grew salmonella enteriditis phage type 4 sensitive to ciprofloxacillin, which was commenced. Subsequent C T scan confirmed a large false aneurysm of the popliteal artery with surrounding soft tissue suppuration and oedema. These findings were suggestive of ruptured popliteal artery, secondary to a salmonellosis-induced mycotic aneurysm rather than deep venous thrombosis. He was taken to theatre, and a reversed long saphenous vein femoro-popliteal bypass graft was performed with the graft tunnelled subcutaneously through uninfected tissue. The intervening popliteal artery with its mycotic portion was ligated proximal and distal to the area of sepsis. Necrotic tissue in the muscle compartments of the thigh and popliteal fossa was debrided and the wound left open. Salmonella was cultured from pus specimens obtained intra-operatively. The patient made a slow recovery on the intensive care unit and was discharged back to the ward on the tenth postoperative day with a clean healing wound and a functioning bypass graft.