SHM Converge Scientific Abstract ePoster Gallery-Risking Life and Limb: Popliteal Arterial Aneurysm as a Previously Unreported Cause of Rhabdomyolysis and Compartment Syndrome

Risking Life and Limb: Popliteal Arterial Aneurysm as a Previously Unreported Cause of Rhabdomyolysis and Compartment Syndrome

Back to course

Pdf Summary

This case report describes a 63-year-old man with two days of right leg swelling, severe pain, numbness, and a violaceous livedo reticularis rash. His history was notable for hyperlipidemia, tobacco use, peripheral vascular disease, and multiple prior arterial aneurysms and bypass surgeries.<br /><br />On exam, he had delayed capillary refill but preserved distal pulses. He also had weakness of ankle dorsiflexion and plantarflexion and marked tenderness of the leg compartments. Venous duplex was negative for DVT, and arterial duplex showed triphasic flow to the foot. CTA revealed distal superficial femoral and popliteal saccular aneurysms with a thrombosed aneurysm at the superior margin of the right popliteal fossa. His creatine kinase was markedly elevated at 15,284, consistent with rhabdomyolysis.<br /><br />He was started on IV fluids and heparin. Initially, compartment syndrome was not strongly suspected because the compartments were still distensible, so he was transferred for vascular surgery management. However, on arrival the anterior compartment became tense, and he underwent emergent four-compartment fasciotomy. He later had endovascular repair of the aneurysms, though his course was complicated by hemorrhagic shock on heparin and a separate jejunal bleed treated with coil embolization. He eventually recovered strength and no longer required a cane.<br /><br />The authors propose that the thrombosed popliteal aneurysm caused ischemia and possibly extrinsic compression, leading to rhabdomyolysis and then compartment syndrome. They emphasize that lower-extremity arterial aneurysms should be considered a potential cause of rhabdomyolysis and impending compartment syndrome, even when distal pulses remain present.

Asset Subtitle

Tony Kuzhippala

Meta Tag

Author List Tony Kuzhippala

Category Clinical Vignettes

Concept Lower Extremity Arterial Aneurysm

Concept Compartment Syndrome

Concept Fasciotomy

Concept Rhabdomyolysis

Concept Arterial Ischemia

Distinguished Non-Finalist

Presenter Organization Emory Johns Creek Hospital

Presenting Author Tony Kuzhippala

Track Adult

Keywords

popliteal aneurysm

rhabdomyolysis

compartment syndrome

lower extremity ischemia

arterial thrombosis

fasciotomy

peripheral vascular disease

livedo reticularis

endovascular repair

distal pulses preserved

Lower Extremity Arterial Aneurysm

Compartment Syndrome

Fasciotomy

Rhabdomyolysis

Arterial Ischemia