Cystic adventitial disease
 Discussion of Cystic adventitial disease
- Cystic adventitial disease (CAD) occurs when mucoid cysts in the adventitia compress the popliteal artery.
- The popliteal artery is the most common location (85% of cases)
- CAD is rare, accounting for only 0.1% of vascular disease.
- Patients are usually men in their mid-40s who present with intermittent claudication.
- Because CAD is a rare condition, treatment methods are derived anecdotally.
- Surgical evacuation of the cysts with maintenance of the native artery appears to be the preferred treatment.
- Occasionally, the artery cannot be preserved and a vein graft is required.
 Imaging Findings for Cystic adventitial disease
- Duplex US will depict an arterial stenosis with surrounding cysts, which contain no flow.
- These cysts appear as anechoic or hypoechoic masses in the wall of the vessel.
- The cysts can manifest as distinctive stenoses of the vessel lumen.
- If the cysts are concentric, the stenosis will have an "hourglass" appearance
- If they are eccentric, the stenosis will demonstrate the classic "scimitar sign."
- Cysts are hyperintense on T2-weighted MR images and have variable signal intensity on T1-weighted images because of the variable amount of mucoid material within the cysts.
- Compression of the popliteal artery produced by cysts can be seen on axial MR images and angiographically with three-dimensional time-of-flight imaging.
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 References for Cystic adventitial disease
- Lonnie B. Wright, W. Jean Matchett, Carlos P. Cruz, Charles A. James, William C. Culp, John F. Eidt, and Timothy C. McCowan. Popliteal Artery Disease: Diagnosis and Treatment. RadioGraphics 2004 24: 467-479.