Presentation
The patient presented with bilateral knee pain at rest. There is negative trauma. The pain is aggravated on exertion.
Patient Data
Features consistent with moderate osteoarthritis of bilateral knees (Kellgren and Lawrence grade III). This is demonstrated by significant medial joint space narrowing, tibial spine irregularity, subchondral sclerosis with minimal femorotibial and patellofemoral spurring. This suggests bicompartmental osteoarthritis. There is no reactive bursitis. There are no occult bone lesions. There is incidental curvilinear calcification within the popliteal fossa bilaterally.
Ultrasound confirmed bilateral small popliteal artery aneurysms with significant mural thrombus and reduced luminal caliber especially right-sided.
Case Discussion
X-rays confirm osteoarthritis which may explain the patient's pain. The finding of bilateral popliteal arterial aneurysms further explains the claudication being experienced on exertion, with likely compromised blood supply to the lower limbs due to peripheral vascular disease and the popliteal arterial aneurysms.
The differential diagnosis of popliteal fossa calcification includes a popliteal arterial aneurysm, a calcified popliteal fossa cyst (Baker cyst), and a whole host of benign and malignant osseous and soft tissue neoplastic lesions. Infective, inflammatory disorders, congenital and post-traumatic abnormalities need to be considered too.
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