Adventitial cystic disease mimics deep venous thrombosis

(HealthDay)—Adventitial cystic disease of the common femoral vein can be mistaken for deep venous thrombosis, according to a case report published online March 8 in the Annals of Internal Medicine.

Sean O'Loghlen, M.D., from Queen's University in Kingston, Canada, and colleagues describe unilateral lower extremity swelling in a 31-year-old woman. The patient presented to the emergency department with a four-day history of painless progressive swelling in the right lower extremity and paresthesia. Examination revealed tense edema of the entire right leg, accompanied by erythema, calor, and superficial vein distension, with no evidence of neurologic or vascular compromise. She was discharged with low-molecular weight heparin therapy for suspected deep venous thrombosis and referred for Doppler ultrasonography.

Doppler ultrasonography identified moderate compression of the right common femoral vein due to a circumferential, hypoechoic, avascular lesion. There was almost complete occlusion of the right common femoral vein and associated enlargement of the superficial femoral and greater saphenous veins on computed tomography of the pelvis. The patient was diagnosed with adventitial cystic disease of the common femoral vein and underwent surgical cyst resection. A benign, adventitial cystic mass with no epithelial lining of the cyst wall was confirmed on pathologic tests. The surgery was tolerated and symptoms resolved.

"Adventitial cystic disease is commonly mistaken for deep venous thrombosis; however, its symptoms do not resolve with anticoagulation," the authors write.

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