Monckeberg medial calcific sclerosis is a form of arteriosclerosis characterized by calcific deposits within the media of medium and small muscular arteries that do not cause luminal narrowing. The calcification is typically diffuse and circumferential along the vessel and is readily visible on plain film.

The exact pathogenesis is unknown but it is more common with advancing age, diabetes and chronic renal disease. This patient also has a popliteal artery aneurysm, presumably due to a superimposed atherosclerotic plaque. Popliteal artery aneurysms are bilateral in 60-70% and are associated with abdominal aortic aneurysms in 30-50%. There is a strong male predilection (male to female ratio of 15:1). The commonest complications are in situ thrombus and distal thromboembolism; rupture is rare. 

Credit: Dr Donna D'Souza