The pseudothrombophlebitis syndrome: a reappraisal

Popliteal cysts in adults: a review

OBJECTIVE

To review the epidemiology, clinical presentation, pathogenesis, imaging, differential diagnosis, complications, and treatment of popliteal cysts.

METHODS

References were taken from MEDLINE from 1985 to 1998 under the subject "Popliteal Cyst" with subheadings of Radiography, Ultrasonography, and Radionuclide Imaging. Other pertinent references were used. Childhood cysts were excluded.

RESULTS

Depending on the studied population and the imaging technique, 5% to 32% of knee problems may have these cysts, with 2 age-incidence peaks of 4 to 7 years and 35 to 70 years. In older patients there is usually coexistent joint pathology. Symptoms may arise in the popliteal fossa from the cyst itself or be dominated by knee pain from coexisting knee pathology. Many cysts are asymptomatic. Physical examination will miss one half of these cysts. Pathogenesis depends on the connection between the joint and bursa, with a valvelike effect allowing passage of fluid from the joint into the bursa with subsequent distention producing these cysts. Some bursae have no such joint-bursal communication, and the cysts arise primarily as bursitis of the gastrocnemio-semimembranosus bursa. Imaging is performed by plain x-ray, ultrasound, arthrography, computerized axial tomography, magnetic resonance imaging, or nuclear scan; sonography is the method of choice. Complicated cysts with extension or rupture into the calf mimic phlebitis, an important differential diagnosis. Asymptomatic cysts found incidentally need no treatment; most symptomatic cysts respond to intra-articular corticosteroid injections. Surgical excision is rarely necessary.

CONCLUSIONS AND RELEVANCE

Popliteal cysts are fairly common, may not be found on physical examination, require imaging (preferably sonography) to be identified, mimic phlebitis when extending into the calf, and often respond to intra-articular steroid or, rarely, surgical resection.

Thrombophlebitis and pseudothrombophlebitis in the ED

The patient presenting to the emergency department (ED) with a painful swollen lower extremity is considered to have deep venous thrombosis (DVT) until this diagnosis can be ruled out. This clinical presentation, however, is far from specific and the differential diagnosis includes symptomatic Baker's cyst, also known as pseudothrombophlebitis syndrome (PTP). This article presents two cases of PTP and reviews the literature relevant to diagnosis of DVT and PTP. Ultrasonography is now the diagnostic test of choice for both DVT and PTP, being safe, accurate, noninvasive, and rapid, and should ideally be available for use in the ED.

Bilateral pseudothrombophlebitis

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Cytomegalovirus pneumonia in a patient with rheumatoid arthritis treated with low dose methotrexate and prednisone

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Rheumatoid arthritis: clinical features and pathogenetic mechanisms

Rheumatoid arthritis is a disorder characterized by chronic inflammation affecting predominantly articular tissues, leading in some instances to disruption of the normal structure and function of the joint. In some patients extra-articular manifestations are also present. In the joints, the pathologic lesion consists of synovial cell proliferation with infiltration by inflammatory cells. The complex interaction among these cells is likely responsible for the connective tissue abnormalities that characterize the rheumatoid lesion. The factors responsible for inducing the inflammatory process are unknown.

Hyperalgesic pseudothrombophlebitis. New syndrome in male homosexuals

Five male homosexuals, four of whom had Kaposi's sarcoma, presented with painful swelling of the lower extremity. The overlying skin was erythematous and exquisitely tender. Deep vein thrombosis was strongly suspected in all patients. Venography, however, revealed no evidence of venous occlusion. This condition, which in this report is termed the hyperalgesic pseudothrombophlebitis syndrome, appears to be another unusual manifestation of the acquired immune deficiency syndrome. It should be considered among the entities known to mimic deep vein thrombosis and must be recognized in order to prevent unnecessary anticoagulation in these patients.