A rare case of symptomatic aneurysm of posterior tibial arte
Aneurysms of the infrapopliteal region are uncommon. Of them, true aneurysms are very rare and that of the posterior tibial artery (PTA) are extremely rare. Published in the Indian Journal of Vascular and Endovascular Surgery, the authors present a case of a 25-year-old female presented with a pulsatile mass behind the right medial malleolus for 1-year duration.

A 25-year-old female presented with a history of a painful pulsatile mass in the medial aspect of the right leg for 1 year. In the past 4 months, it increased in size and had become painful. There was no history of trauma, and the patient's history is not significant. On examination, there was a 3 cm × 2 cm size pulsatile mass behind the right medial malleolus. There was no thrill or bruit. Pedal pulses were palpable. There was no evidence of any other aneurysm on clinical examination.

Color Doppler of the right lower limb revealed a PTA aneurysm. An computed tomography angiogram was performed which confirmed a saccular PTA aneurysm with patent pedal arteries. A screening color Doppler excluded the presence of an aneurysm in any other part of the body. Laboratory investigations including erythrocyte sedimentation rate, C-reactive protein, and antinuclear antibodies were normal.

The patient was symptomatic, and the aneurysm size was increasing as per the history, and, because of that, the patient was scheduled for surgical intervention. The aneurysm was resected, and PTA was reconstructed with a interposition reverse great saphenous vein graft.

Histopathological examination revealed intimal fibrosis with increased inflammation composed of lymphocytes, few neutrophils, and foamy macrophages with fragmentation of internal elastic lamina, features consistent with vasculitic changes.

Key takeaways:-
- False aneurysms are more common in comparison to the true aneurysms of infrapopliteal blood vessels.

- Differential diagnoses of a true aneurysm include tendon cyst, neurinoma, soft-tissue tumor, or pulsatile masses.

- In our case, though preoperative assessment could not find any etiological factor for the aneurysm development, histopathological examination revealed the possibility of vasculitis.

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