Heterotopic ossification in right popliteal fossa causing arterial insufficiency

Abstract

Heterotopic ossification (HO) is the abnormal formation of extra-skeletal bone in soft tissue, which can occur after trauma or surgery. HO in joints can cause pain, hinder mobility, and compress surrounding nerves and blood vessels. We present an unusual case of arterial insufficiency caused by HO in the right popliteal fossa.

Keywords: Arterial insufficiency; Heterotopic ossification; Popliteal artery; Popliteal fossa; Vascular compression.

Fig 1

Axial proton-density fast-spin echo fat-suppressed (A), sagittal T2-weighted magnetic resonance image (B), and coronal T1-weighted fast spin echo (C) magnetic resonance images of the lower extremity, showing three large ossicles in the popliteus tendon sheath, measuring ≤3 cm anteroposteriorly. The ossicles (white arrows) resulted in deformity of the popliteal artery (red arrows) with a mildly narrowed lumen.

Fig 2

Ankle brachial indexes (ABIs), segmental limb pressures, and pulse volume recordings, showing a low ABI of 0.55, with dampening of the waveforms below the level of the knee due to compression from the heterotopic ossification (HO). DP, Dorsalis pedis; L, left; PT, posterior tibial; R, right.

Fig 3

Photograph of the surgical incision. A posterior approach to the popliteal artery was taken with a “lazy S” incision over the popliteal fossa.

Fig 4

Photograph of the heterotopic ossification (HO), an unoriented, 3.9 × 1.9 × 2.8-cm portion of tan-red, calcified tissue encased in a minimal amount of red-tan, focally cauterized soft tissue.