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1415 - Exercise-Induced Unilateral Leg Paresthesia in A Pediatric Athlete

Thursday, February 27, 2025

5:00 PM - 6:30 PM MST

Presenting Author(s)

NW

Noah West, BS

Medical Student
Lake Erie College of Osteopathic Medicine
Sayre, Pennsylvania, United States

Co-Author(s)

RG

Rex David Gido, DO

Sports Medicine Physician
Guthrie Medical Group
Cortland, New York, United States
WS

William St.Marie, BS

Medical Student
Lake Erie College of Osteopathic Medicine
ELMIRA, New York, United States

Case Diagnosis: Right external iliac artery endofibrosis.

Case Description: A previously healthy fifteen-year-old girl presented to our outpatient clinic with progressive paresthesia involving her right leg for the past year, which was brought on by running and would resolve within a minute of rest. The patient attempted physical therapy without improvement. Physical examination was notable for decreased right posterior tibial and dorsalis pedis artery pulses when passive ankle dorsiflexion was induced. Ultrasound of the right lower extremity showed triphasic pulses at rest. However, the superior femoral and popliteal arteries became monophasic after exercise and returned to normal after three minutes of rest. On the CT angiogram, at least a moderate degree of luminal narrowing was noted at a short segment of the proximal right external iliac artery. An open right external iliac artery endofibrosectomy was performed successfully with bovine pericardial patch angioplasty. Claudication symptoms were no longer present with the return to normal activity levels.

Discussions: The unique aspect of the case we presented was the remarkably young age at presentation, alongside the absence of high-level endurance training, which led to delayed diagnosis given the lack of common risk factors for endofibrosis. Endofibrosis is thought to be a product of repetitive injury, commonly affecting the iliac arteries, resulting in luminal narrowing and claudication symptoms induced by exercise. Symptoms of peripheral artery disease are most often the result of atherosclerosis, but in young, healthy populations with no risk factors, endofibrosis is a differential etiology frequently overlooked. Due to the low prevalence and vague symptoms, proper diagnosis becomes delayed as other causes, such as musculoskeletal or neurologic, are explored first.

Conclusions: From this report, we aim to equip physicians with the ability to recognize an underdiagnosed pathology in an uncommon population.