Popliteal Venous Aneurysm and Pulmonary Embolism Initially Presenting with Recurrent Pre-syncope: A Case Report

INTRODUCTION: Popliteal venous aneurysm (PVA) can lead to recurrent pulmonary embolism (PE) and therefore necessitates prompt diagnosis and treatment. PVAs are often asymptomatic, and their most common symptoms are associated with thrombosis. The clinical presentation of PVAs varies from asymptomatic to PE induced cardiopulmonary arrest, but there are few reports of cases initially presenting with transient impairment of consciousness. REPORT: A 75 year old man was referred with recurrent episodes of pre-syncope. He had normal vital signs and oxygen saturations, and his electrocardiogram was normal. Detailed interview revealed that the patient had suffered from calf pain and swelling before visiting the clinic. Therefore, an evaluation for deep venous thrombosis and PE was conducted. Lower limb ultrasound revealed an enlarged popliteal vein, measuring 20 mm in diameter, with a spontaneous echo contrast. Enhanced computed tomography showed peripheral pulmonary artery embolism. The patient was diagnosed with PE secondary to PVA. An inferior vena cava filter was inserted, followed by tangential aneurysmectomy and lateral venorrhaphy; apixaban 10 mg/day was initiated on post-operative day 1. The filter was removed one week after the surgery, and the patient remained symptom free on completion of treatment and did not complain of any symptoms such as pre-syncope. DISCUSSION: This patient with PVA presented with the initial symptoms of repeated pre-syncopal episodes that were attributed to recurrent PE caused by thrombi from a PVA. Complete symptom resolution was obtained by inferior vena cava filter placement, PVA surgery, and post-operative anticoagulation. Transient consciousness disorders such as pre-syncope can be the initial symptoms of PVA and PE.