Aneurysma der Vena poplitea als Ursache rezidivierender Lungenarterienembolien mit Reanimationspflichtigkeit

History and admission findings: A previously healthy 40-year-old varnisher was admitted because of increasing dyspnoea. His clinical status rapidliy 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. Investigations: The concentration of D-dimers was raised. Pulmonary angiography demonstrated multiple bilateral occlusions of the segmental arteries. Treatment and course: 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. Conclusion: 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.