Asymptomatic rupture of a popliteal arterial aneurysm (AAP) is rare but has been previously reported in the literature. Here, we present the first case of a thrombosed AAP that ruptured and developed into an abscess. We present the case of an 83-year-old male patient who was admitted to the emergency room in an impaired general condition, with a 3-month history of a daily fever that mainly occurred in the evening (38°C), a lack of appetite, and weight loss of 18 kg over 3 months. On initial physical examination in the emergency room, the patient presented with fever (37.8°C), a heart rate of 105 bpm, a blood pressure of 110/70 mm Hg, and bulging in the posterior aspect of the right thigh that was hard, painless, without hyperemia, and without localized heat on palpation. The femoral pulses were normal bilaterally, but the popliteal and distal pulses in the right lower limb were absent. A magnetic resonance imaging demonstrated thrombosis of the right AAP associated with continuity contour loss and images compatible with collection with low degree on T1 and intermediate signal intensity on T2, which may correspond to the subacute bleeding areas that measured 10.6 × 5.9 × 4.0 cm and that were located between the muscle belly of the sartorius, semimembranosus, and vastus muscles inferiorly. There was another collection (with similar characteristics) that measured 5.4 × 4.2 × 2.4 cm and that was located medially from the biceps femoral muscle. The patient consented to the resection of the aneurysm and the ligation of the collateral arteries. First, we dissected down to the femoral artery proximal to the aneurysm and the popliteal artery at the P2 segment where there was no evidence of infection or rupture. The surgical wound was washed with 10 L of 0.9% saline solution, samples were sent to pathology for culture, and the surgical wound was drained with a closed drain. We decided not to revascularize the limb because there was good perfusion and a current infection.
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