title: Magnetic resonance imaging: occult popliteal artery entrapment syndrome in a young soldier.
abstract: BACKGROUND
  Popliteal artery entrapment syndrome (PAES) is frequently misdiagnosed because of symptom overlap with other conditions and lack of a definitive diagnostic modality. The incidence is widely variable, although it should be considered in all patients under 50 years with symptoms of lower extremity claudication. Long-term sequelae of PAES include critical limb ischemia, arterial occlusion, and aneurysm formation caused by repetitive external compression.
  
  
  METHODS
  We review the case of a 27-year-old soldier originally treated for exertional compartment syndrome with fasciotomies without relief of symptoms. Magnetic resonance imaging (MRI) failed to demonstrate an aberrant slip of the gastrocnemius muscle, which was ultimately found and released on surgical exploration.
  
  
  RESULTS
  Surgical exploration and release of an aberrant band of gastrocnemius muscle through a medial approach resulted in significant relief of symptoms and improvement of walking distance.
  
  
  CONCLUSIONS
  Healthy athletes without peripheral vascular disease and symptomatic calf and foot claudication should have an early referral to vascular surgery. The risk of false-negative MRI warrants further investigation into provocative, noninvasive imaging modalities to properly classify PAES. This report reviews the literature to discuss the diagnostic challenges, natural history of disease, and surgical interventions for PAES.
authors.affiliation: Division of Vascular Surgery, San Antonio Military Medical Center, San Antonio, TX. Electronic address: michael.s.clemens.mil@mail.mil.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Clemens
authors.affiliation: Division of Vascular Surgery, San Antonio Military Medical Center, San Antonio, TX.
authors.forename: John Devin B
authors.initials: JD
authors.lastname: Watson
authors.affiliation: Division of Vascular Surgery, San Antonio Military Medical Center, San Antonio, TX.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Scott
authors.affiliation: Division of Vascular Surgery, San Antonio Military Medical Center, San Antonio, TX.
authors.forename: Sean J
authors.initials: SJ
authors.lastname: Hislop
authors.affiliation: Division of Vascular Surgery, San Antonio Military Medical Center, San Antonio, TX.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Heafner
authors.affiliation: Division of Vascular Surgery, San Antonio Military Medical Center, San Antonio, TX.
authors.forename: Zachary M
authors.initials: ZM
authors.lastname: Arthurs
mesh_terms: D000328:Adult; D000792:Angiography; D001157:Arterial Occlusive Diseases / Q000175:diagnosis* / Q000601:surgery*; D003251:Constriction, Pathologic; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008889:Military Personnel; D018482:Muscle, Skeletal / Q000601:surgery*; D011150:Popliteal Artery