A unique case of compartment syndrome due to a ruptured mycotic popliteal artery aneurysm

Abstract

A man in his 60s was admitted to our institution for workup of newly diagnosed ischemic heart disease. This was on the background of recent hospital admission with Salmonella typhimurium bacteraemia of unknown source. During his admission the patient developed progressively worsening left leg pain. Duplex US demonstrated a below knee DVT, however subsequent triple phase CT revealed a ruptured mycotic popliteal artery aneurysm. The patient was transferred for emergent superficial femoral artery to below knee popliteal artery bypass graft using the reversed contralateral greater saphenous vein with associated aneurysmectomy. The patient went on to make a successful recovery. Mycotic aneurysms involving Salmonella species have been documented in the abdominal aorta; however, remain a rare occurrence in popliteal arteries1. Cross sectional arterial imaging is recommended when there is suspicion of peripheral arterial bacterial seeding, in order to accurately capture mycotic aneurysms. This case highlights the importance of having a low threshold for arterial imaging in a patient with a history of Salmonella bacteraemia and acute limb pain.