腓肠肌外侧头附属肌束致腘血管陷迫综合征的影像学诊断

The imaging diagnosis in popliteal vascular entrapment syndrome caused by anomalous slip of the lateral head of the gastrocnemius muscle

目的探讨影像学检查方法在腓肠肌外侧头附属肌束致腘血管陷迫综合征(Popliteal vascular entrapment syndrome,PVES)中的诊断价值,增加对该病的认识。方法回顾性分析4例经手术病理证实的由腓肠肌外侧头附属肌束致腘血管陷迫综合征患者的影像学资料,包括多普勒超声、数字减影血管检查(DSA)、CT血管成像(CTA)及磁共振检查(MRI)。结果 4例患者中,2例患者腘动脉受累闭塞;1例患者双侧腘静脉内移,左侧腘静脉血栓形成;1例患者左侧腘动静脉均受累,造成左侧腘动脉闭塞,左侧腘静脉及股静脉血栓形成,血栓脱落后造成肺动脉栓塞,慢性血栓栓塞性肺动脉高压及肺心病。4例患者中,超声及DSA检查均能够发现腘动脉及腘静脉的形态变化,术前未明确PVES诊断。CTA及MRI检查能够清晰显示腘窝内腘血管与异常肌束间的关系,明确诊断,与手术结果一致。结论腓肠肌外侧头附属肌束致腘血管陷迫综合征是一种少见的疾病,影像学检查对于该病的诊断与治疗有重要价值。

Objective To evaluate the diagnostic value of imaging techniques in the popliteal vascular entrapment syndrome caused by an accessary muscle slip of the lateral head of the gastrocnemius muscle. Methods 4 patients who underwent surgical treatment for PVES caused by the accessary muscle slip of the lateral head of the gastrocnemius muscle were evaluated retrospectively. The imaging examination findings included Doppler sonography, DSA, CT angiography and MRI were reviewed. Results Two cases of Popliteal artery occlusion in 2 cases, 1 case of medial displacement of bilateral popliteal veins and tbrmation of thrombosis in the left popliteal vein, I case of compression of both popliteal arteries and veins were found. Doppler sonography and DSA can clearly show the anatomic features of a vascular lesion of the popliteal artery and vein, but not sufficient to render a diagnosis of PVES. Both CTA and MRI can provide optimal visualization of the popliteal vessels and the surrounding anomalous slip of muscle and confirm the diagnosis of PVES, which was consistent with intraoperative photography. Conclusion PVES caused by an accessary muscle slip of the lateral head of the gasctrocnemius muscle are rare, and imaging examination is important in diagnosis and treatment of the disease.