Ruptured Baker's cyst causes ecchymosis of the foot. A differential clinical sign

Infected Baker's Cyst: A New Classification, Diagnosis and Treatment Recommendations

Introduction:

Baker’s cyst has a high prevalence in adult population. Despite being usually asymptomatic, cyst complications may develop, such as an infection, rupture and content dissemination into the calf. This clinical presentation has a low incidence with few reports in the literature. We have not found any publication describing a systematic approach for its treatment. The purpose of this study is to propose a new classification, diagnosis, and treatment recommendations based on a case report and a literature review to guide physicians on the best course of treatment.

Case Report:

A 53-year-old man presented with sudden left popliteal pain associated with progressive knee and calf swelling and limited knee flexion. After the initial evaluation, a Baker’s cyst rupture and dissemination into the calf, associated with a septic arthritis, were diagnosed. An arthroscopic surgical irrigation of the knee and open debridement of the calf collection were performed.

Conclusion:

Our classification may allow an accurate and structured description of the different stages of Baker’s cyst presentations, with simplification of the clinical description, diagnosis, and treatment approaches.

Cellulitis and the Prevalence of Deep Vein Thrombnosis

From February, 1994, to August, 1995, we reviewed the venous duplex ultrasound findings of 207 consecutive patients who presented with clinically evident lower leg cellulitis to determine if thrombophlebitis plaued a role in this entity. All patients had a recent onset of intense erythema of the lower leg with associated pitting edema and diffuse painful cutaneous or subcutaneous tenderness. One hundred ninety-one patients (92%) had normal venous duplex ultrasound examinations, with no evidence of any acute or chronic disease. Four patients (2%) had superficial thrombophlebitis involving the greater saphenous vein in the lower leg only, and 10 patients (5%) had evidence of chronic obstructive disease with recanalizattion and post-thrombotic popliteal venous insufficiency. In a subset of 73 patients aged more than 60 years, arterial evaluation with Doppler spectral waveform analysis showed significant obstructive disease in 41 (56%); 17 of the 19 patients with diabetes in this subset (89%) were noted to have positive arterial examinations. Theae data indicate that when the clinical diagnosis of cellulitis can be made, there is no associated significant acute deep venous thrombosis, and venous duplex ultrasound testing is not indicated. In oldet patients, particularly patients with diabetes, arterial testing for obstructive disease appears to be most appropriate.

Baker's Cyst Filled with Hematoma at the Lower Calf

Baker's cyst is a distension of the gastrocnemius-semimembranosus bursa of the knee, which communicates with the posterior portion of the joint capsule. Baker's cyst is commonly located in the inferomedial or superficial layers of the knee joint and rarely extends laterally or proximally. Complications of Baker's cysts are dissection, rupture, pseudothrombophlebitis, leg ischemia, nerve entrapment, and compartment syndrome. However, hematomas in the Baker's cyst have not been reported in Korea. We report a rare case of hematoma in the Baker's cyst with subfascial extension into the calf. The hematoma was demonstrated by magnetic resonance imaging and removed by mass excision.

Popliteal cysts: a current review

Baker's cyst, or popliteal cyst, is a fluid-filled mass that is a distention of a preexisting bursa in the popliteal fossa, most commonly the gastrocnemio-semimembranosus bursa. This bursa is unique in that it communicates with the knee joint, unlike other periarticular bursae, via an opening in the joint capsule posterior to the medial femoral condyle. Many have theorized that this opening creates a valve-like mechanism in the presence of effusion that contributes to the formation of these cysts in adults. Popliteal cysts rarely manifest alone and are most often found in conjunction with other intra-articular pathologies and inflammatory conditions, such as osteoarthritis, meniscus tears, and rheumatoid arthritis. In children, popliteal cysts are only occasionally associated with these conditions and are more often an incidental finding discovered during a routine physical examination. Popliteal cysts may present as either a chronically persistent or relapsing condition or as an acute and dramatic condition that can occur in the case of cyst rupture presenting as pseudothrombophlebitis. Ultrasound and magnetic resonance imaging have proven to be consistent and accurate in the confirmation of popliteal cysts, with magnetic resonance imaging becoming the modern imaging modality of choice. This review discusses the anatomy and etiology of popliteal cysts, describes the common clinical presentations, reviews the differential diagnoses, and provides guidance for proper diagnostic imaging. It also provides a comparison of current conservative, minimally invasive, and invasive treatment options, along with a discussion of results. Postoperative rehabilitation depends largely on the condition associated with the popliteal cyst.

A pyogenic, ruptured Baker's cyst induced by arthroscopic pressure pump irrigation

Post-steroid septic arthritis can be treated with irrigation pump assisted arthroscopic synovectomy. The high-intra-articular fluid pressures can force the pyogenic fluid into a pre-existing Baker's cyst. The cyst can rupture and with the pre-existing steroid induced immune-suppression, the calf abscess will be hard to control. Therefore, thorough investigation with an ultrasound-guided aspiration followed by an early drainage of the collection is warranted and mandatory. Close monitoring for the development of a deep thrombosis of the popliteal vein is required.

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.

Posterior tibial neuropathy from ruptured Baker's cyst

OBJECTIVES

To increase awareness of entrapment neuropathy caused by rupture of Baker's cyst.

METHODS

A patient with psoriatic arthritis, ruptured Baker's cyst, and entrapment neuropathy is reported and the literature on this complication is reviewed.

RESULTS

Nerve entrapment caused by rupture of Baker's cyst is rare. Neurological examination and demonstration of Baker's cyst by Color Doppler Duplex Ultrasound (CDDU) help in making the diagnosis. Nerve Conduction Study (NCS) may confirm the diagnosis of posterior tibial nerve entrapment.

CONCLUSIONS

Peripheral nerve entrapment should be considered in patients with Baker's cysts and loss of sensation along the plantar aspect of the foot or other neurological symptoms or findings.

Baker's cysts mimicking the symptoms of deep vein thrombosis: diagnosis with venous duplex scanning

PURPOSE

The purpose of this study was to determine the incidence and characteristics of Baker's cysts discovered during venous duplex examinations to rule out deep vein thrombosis (DVT).

METHODS

We reviewed the vascular laboratory charts of patients found to have Baker's cysts during venous duplex studies to rule out DVT from October 1988 through December 1995.

RESULTS

Ninety-five (3.1%) of 3072 patients who underwent venous duplex studies were found to have 111 Baker's cysts. Seven of the 95 had coexistent DVT. Ten patients had ruptured cysts, whereas six patients had cysts that compressed the popliteal vein.

CONCLUSION

The presentation of DVT and that of a Baker's cyst are similar enough to be difficult to distinguish by clinical examination. Careful examination of the popliteal fossa should be performed during venous duplex examinations regardless of the indication for the study.