Expanding the differential for a bounding popliteal artery pulsation on physical exam
Dear Dr. Waksman,
Physical examination, prior to the coronary angiogram, revealed bounding right popliteal artery pulsations “3/2.” These exam findings, coupled with the coronary anatomy, prompted both an abdominal aortic artery ultrasound as well as popliteal artery ultrasound. Surprisingly, there was no evidence of either an abdominal aortic aneurysm or popliteal artery aneurysm, but there was an engorged popliteal vein with an acute deep venous thrombosis (Fig. 1). Anatomically, the popliteal vein overlies the popliteal artery and it was this pulsation transmitted through an enlarged, acutely occluded popliteal vein, which resulted in the physical exam findings. Presentation of this case is interesting because it appears to be the first reported case of an acutely occluded popliteal vein in the differential for an engorged and bounding “popliteal artery” on physical exam.