Case Study: Ultrasound Reveals Sciatic Neuropathy and Life-Threatening Peripheral Vascular Disease

Our Patient

Our patient is a 62-year-old female complaining of leg pain, calf and foot muscle weakness, and sensations of numbness in her lower extremities.

Our Diagnostic Approach

Our initial clinical exam indicated neuropathy, which we confirmed with multiple EMG tests. We followed up with an examination by high-resolution diagnostic ultrasonography.

Our ultrasound exam of the sciatic nerves revealed the following:

• The size of the tibial and peroneal portions was consistent on the right and left sides.
• Signs of sciatic neuropathy were more prominent on the right side.

Ultrasound imaging also revealed alarming muscle and vascular anomalies:

• Muscle atrophy (shrinkage) in the right calf and decreased pennation angle of the muscle fibers (15 degrees on the right, compared to 23 degrees on the left).
• Complete occlusion (blockage) of the right popliteal artery.
• Complete occlusion of the right femoral artery at the level of the inguinal ligament.
• Narrowing of the right posterior tibial artery due to arterial wall deposits.
• Near-total occlusion of the left popliteal artery.
• Evidence of sporadic calcified plaques in the affected arteries.

Our Solution

We recommended that our patient consult with a vascular surgeon, as her condition was dire and beyond the scope of our practice.

Conclusion

Had we based our diagnosis on the patient’s symptoms and our clinical exam alone, we would not have been alerted to her peripheral vascular disease. In this case, our high-resolution diagnostic ultrasonography was able to detect critical vascular anomalies that might have been overlooked until the patient suffered a life-threatening cardiovascular event.