Aneurysm of the popliteal vein causing pulmonary thromboembolism that required resuscitation

A previously healthy 40-year-old varnisher was admitted because of increasing dyspnoea. His clinical status rapidly deteriorated. He was referred to a cardiology intensive care unit but had to be resuscitated during transport. His condition became stable under controlled ventilation and analgesics. There were no other contributory abnormal findings. The concentration of D-dimers was raised. Pulmonary angiography demonstrated multiple bilateral occlusions of the segmental arteries. Extubation became possible after thrombolysis with recombinant tissue plasminogen activator (rTPA). There was no evidence of leg or pelvic vein thrombosis. But a hard mass was palpated in the left popliteal fossa and extensively thrombosed saccular aneurysm of the popliteal vein was found. The aneurysm was resected and a venous graft was interposed. There were no further thromboemboli under oral anticoagulation. Two years later the venous graft was occluded with adequate collateral circulation. Aneurysm of the popliteal vein is a rare vascular anomaly of unknown pathogenesis. In patients with repetitive episodes of lung embolism peripheral aneurysms must be taken into consideration.