Atypical Calf Cyst Treated With Doxycycline Sclerotherapy: A Case Report

ABSTRACT

There are many types of cysts in the leg; the most common is a popliteal (Baker's) cyst. This occurs when synovial fluid fills the tissue plane between the medial head of the gastrocnemius and the semimembranosus muscle and is often associated with intraarticular knee pathology. Treatment for various types of cysts includes aspiration with or without fenestration, injections with corticosteroids, dextrose, or various sclerosing agents, and surgical excision. This case describes a 58-yr-old man with a large cyst measuring 14.7 × 2.7 × 3.1 cm in size in the lateral calf, within the lateral gastrocnemius, with atypical size and location for a calf cyst. Computed tomography arthrogram showed intraarticular communication with the knee. The cyst recurred after two aspirations and injections with 25% dextrose/lidocaine. Aspiration and injection with doxycycline resulted in temporary relief followed by recurrence. Complete cyst resolution occurred after final aspiration without injectate. The cyst was likely synovial based on location, intraarticular communication, and fluid analysis. We suspect that complete resolution may have been due to repeated aspiration and injection, essentially performing longitudinal cyst fenestration, with possible contribution from doxycycline injection. Further study of intracyst doxycycline injection with reaspiration after 10 mins for treatment of refractory cysts may be warranted.

Baker's Cyst with Knee Osteoarthritis: Clinical and Therapeutic Implications

OBJECTIVE

Several symptoms are common to knee osteoarthritis and Baker's cyst. To what extent each condition contributes to the patient's discomfort is still a matter of debate. The aim of the present study was twofold: first, to compare the burden of symptoms in patients with isolated knee osteoarthritis and patients with knee osteoarthritis associated with Baker's cyst; second, to assess the outcomes after conservative treatments.

SUBJECT AND METHODS

Patients suffering from monolateral idiopathic knee osteoarthritis were enrolled. Demographic, anthropometric and clinical data (KOOS scale) were collected. Ultrasound evaluation was performed according to standard protocols. On the basis of the clinical presentation different therapeutic options were used (fluid withdrawal, hyaluronic acid and/or steroids injections).

RESULTS

One-hundred and thirty patients were included in the study (97 with isolated knee osteoarthritis, 33 with knee osteoarthritis and Baker's cyst). In basal conditions, lower scores in KOOS sub-scales were observed in patients with knee osteoarthritis associated with Baker's cyst and in patients with effusion compared with patients without effusion. At 3 months after therapy significant higher scores were observed in both groups. At 6 months the scores were unchanged in the patients without Baker's cyst, but worsened in those with Baker's cyst.

CONCLUSIONS

The study shows that Baker's cysts associated with knee osteoarthritis contribute to the burden of symptoms. The conservative treatment of both conditions allows significant improvements, but in the medium term (6 months) the efficacy of the therapy declines in patients with knee osteoarthritis associated with Baker's cyst.

Popliteal (Baker's) Cysts in the Setting of Primary Knee Arthroplasty

BACKGROUND

Popliteal (Baker's) Cysts are rare complications of knee arthroplasty. Enlargement, irritation, or rupture of the cyst can lead to significant pain, tightness, and tenderness. The literature regarding popliteal cysts occurring following knee arthroplasty is limited and does not report prevalence, natural history, and treatment of popliteal cyst in the setting of knee arthroplasty.

METHODS

Following Institutional Review Board approval, 2,025 primary total and partial knee arthroplasties by four surgeons at one institution from 2011-2016 were reviewed for occurrence of popliteal cysts. Twelve cases occurring after arthroplasty were identified, including four unicompartmental knee arthroplasties and eight total knee arthroplasties. Demographic data were evaluated and symptoms, time of onset following arthroplasty, attempted treatment strategies, and success or failure of attempted treatments or interventions were recorded.

RESULTS

The mean age of patients that presented with a popliteal cyst was 63.6 years old (range = 45 - 78 years). There were 5 males and 7 females. The mean BMI was 26.32 (range = 19.0 - 35.0). In 2,205 primary knee arthroplasties performed from 2011-2016 (including 175 partial and 1850 total), the prevalence of popliteal cysts following surgery was 0.6% (n=12). All popliteal cysts were discovered between six weeks and two years following surgery, with the majority occurring during the first year. Twenty-five percent (3/12) of patients presented with minimal symptoms. These were managed expectantly. Seventy-five percent (9/12) were symptomatic. One patient had only a diagnostic ultrasound, two patients underwent ultrasound-guided aspiration and steroid injection, three underwent simple aspiration. Two underwent surgical excision. One cyst ruptured. All cases went on to symptomatic resolution. There was no association with diabetes, smoking, or body mass index. A disproportionately high number (25% or 4/12) occurred in partial knee arthroplasty.

CONCLUSION

While popliteal cysts following primary total knee arthroplasty are rare, they can become a persistent and even disabling problem for arthroplasty patients. Given the lack of formalized recommendations in the existing literature, we propose a treatment algorithm that has been successful in our clinic, including observation initially, ultrasound-guided injection/aspiration if symptomatic, and surgical excision as a last resort.

LEVEL OF EVIDENCE

Level IV.

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.

[Popliteal cysts: etiologic and therapeutic approach]

In children and adults, a popliteal cyst frequently coexists with an intra-articular disorder of the knee. Its mode of presentation consists of a palpable mass at the level of the popliteal fossa. The cyst is a recess of the synovial cavity of the knee, often associated to a chronic effusion. In children, the etiology may be primary with a development directly from the medial gastrocnemius-semimembranous bursa. In adults, it is usually secondary to degenerative or inflammatory disease of the knee. A communication between the intraarticular space and the cystic cavity can be often found. The aim of this study is to review epidemiology, pathogenesis, symptomatology, diagnosis and treatment options.

Ultrasound monitoring of the treatment of clinically significant knee osteoarthritis

OBJECTIVES

The study presented an ultrasound (US) monitoring of treatment as a new imaging US method with the results of therapy of clinically significant knee osteoarthritis.

BACKGROUND

X-ray is widely used for knee osteoarthritis classification, which does not involve the evaluation of the soft tissue. High frequency and high resolution US of joints (arthrosonography, echoarthrography) assess not only morphologic but also functional changes in the knee joint.

METHODS

In the prospective study, 110 patients with clinically significant knee osteoarthritis were treated non-operative. US examination and US monitoring of therapy was performed during 24 weeks therapy period. A remission of pathomorphologic (marginal osteofytes) and pathophysiologic (effusion in anterior knee and Baker´s cyst) attributes were evaluated according the US classification.

RESULTS

Pathomorphologic attributes changes showed a static state, without remission or progression. Pathophysiologic attributes changes showed a remission during the study period. The highest remission was in the first three weeks, 60 % anterior knee effusion and 62 % Baker´s cyst. At the end of study, no changes from the initial US grade was observed in 16 % of effusion in anterior knee and 22 % of Baker´s cyst. Therapeutic resistant Baker´s cyst was present at the end of study in 36 %.

CONCLUSION

We demonstrated a new method - US monitoring of therapy, which can objectivize the efficiency of treatment of clinically significant knee osteoarthritis. We would recommend US monitoring of therapy for the routine use in orthopedic clinical praxis (Tab. 6, Graph 3, Fig. 3, Ref. 15).

A complex assessment of patients with knee osteoarthritis and Baker's cyst: observational study

In our observational study, we performed the clinical and functional examination, analyzed imagistic and histological findings and evaluated the correlation between previous aspects in patients with primary knee osteoarthritis (PKOA) and Baker's cyst (BC). The correlations were made to better understanding of BC in patients with PKOA and optimal choosing for treatment. Seventy patients with painful PKOA (ACR criteria) and BC were assessed. We evaluated knee pain using a 100 mm VAS and functional status using the pain, stiffness and functional subscales of WOMAC index. All patients were imagistic examined (ultrasonography and MRI). Thirty-eight patients with PKOA and simple BC respond to conservative treatments. Thirty-two patients with PKOA and complex BC need surgical removal (arthroscopic decompression ± open excision in larger cysts). For these patients, it is performed histological assessment. Any medical team that manages a PKOA patient with BC may develop the treatment plan based upon not only the size of BC, symptoms and other associated conditions but also on the WOMAC scoring and complex anatomic and histological data about BC.

Ultrasound-guided aspiration and corticosteroid injection compared to horizontal therapy for treatment of knee osteoarthritis complicated with Baker's cyst: a randomized, controlled trial

BACKGROUND

Combining different therapies, physical therapy agents, pharmacological and physical therapies, generally produces better outcomes for symptoms of knee osteoarthritis (OA) than do isolated therapies.

AIM

To demonstrate if horizontal therapy (HT) and aspiration alone and corticosteroid injection alone or in combination determine pain relief and functional improvement in a group of patients with knee OA complicated with Baker's cyst (BC).

DESIGN

We designed a randomized controlled trial (RCT).

SETTING

Outpatients.

POPULATION

Sixty patients with a knee OA and diagnosis of BC confirmed by means of standard ultrasound (US) evaluation.

METHODS

The trial was conducted as a randomized, controlled trial. Patients who satisfied the inclusion criteria were randomized to either the US-guided (Ultrasound Guided BC aspiration and corticosteroid injection group (Group A), the Horizontal Therapy group (Group B) or the US-guided BC aspiration and corticosteroid injection plus Horizontal therapy group (Group C). Outcome measures included: 1) pain reduction as measured by visual analogue scale (VAS); 2) functional improvement, as measured by WOMAC; and 3) US evaluation at baseline (T0), at one (T1) and four (T2) weeks follow-up.

RESULTS

A total of 60 patients were randomized into group A (N.=20), group B (N.=20) or Group C (N.=20). Patients in group A and in group C, but not those in group B maintained lower pain level at T2 than at baseline, with significant lower VAS values in Group C. As regards US measurements, the maximum axial area did not change as a consequence of the treatment in any of the three groups (P=0.259). Contrarily, sagittal area measurements were influenced by time (P<0.01).

CONCLUSION

Our results show that the group with the best performance for pain, functionality and dimension of BC was that in which combined use was made of horizontal and corticosteroid injection therapies.

CLINICAL REHABILITATION IMPACT

In this study we want to demonstrate the effectiveness of Horizontal Therapy in the treatment of knee OA complicated by BC.

Sclerotherapy of Baker's cyst with imaging confirmation of resolution

BACKGROUND

Baker's cysts are commonly encountered in pain management practices.

OBJECTIVE

To ascertain if sclerotherapy treatment of a Baker's cyst could produce objectively verifiable MRI imaging changes.

DESIGN

Case report.

METHODS

A 52-year-old white male with a posterior horn of the medial meniscus tear and a large Baker's cyst who had failed conservative care and drainage was imaged before treatment with sclerosing. Three injections of 12.5% dextrose and anesthetic with sodium morrhuate were injected intraarticular into the right knee after drainage.

RESULTS

The Baker's cyst resolved on both postoperative imaging after the completion of care as well as on physical examination.

CONCLUSIONS

Prolotherapy in this case study seemed to be an effective treatment for Baker's cyst in this patient.

The popliteal cyst

A popliteal cyst, originally called Baker's cyst, is a synovial fluid-filled mass located in the popliteal fossa. The most common synovial popliteal cyst is considered to be a distension of the bursa located beneath the medial head of the gastrocnemius muscle. Usually, in an adult patient, an underlying intra-articular disorder is present. In children, the cyst can be isolated and the knee joint normal. The anatomy, etiopathogenesis, clinical presentation, differential diagnosis, imaging and treatment modalities of the popliteal cyst are presented. The authors try to answer some questions dealing with this condition. Is the cyst isolated, can it be treated as such, is its origin always well-defined and does surgical excision provide a permanent cure?

Meniscal disorders: normal, discoid, and cysts

Meniscal injuries in children and adolescents are being seen with increased frequency. Meniscal tears are typically traumatic injuries in adolescents. Because of increased healing potential and the younger age of these patients, attempts at meniscal preservation should be emphasized for outer and middle third tears. Discoid meniscus typically presents as a snapping knee in younger children or as a meniscal tear in older children. Again, meniscal preservation by saucerization is emphasized. Careful attention should be given to the need for additional meniscal repair. Popliteal cysts typically present as a painless mass. Because they are usually not associated with an internal pathology and often resolve spontaneously, the preferred treatment is observation.

The imaging spectrum of Baker's (Popliteal) cysts

Baker's (Popliteal) cysts are frequently encountered on cross-sectional imaging of the knee. These consist of enlarged gastrocnemius semimembranosus bursa which typically communicate with the knee. They may be imaged with a variety of techniques including arthopgraphy, CT, ultrasound and MRI, with the latter two being more commonly used. Examples of bursa imaged with all of the above techniques are demonstrated in the essay, as well as variance of normal appearance and pathological entities including ruptured bursa, abnormally positioned bursa, osteochondromatosis, septic complications of the bursa and pigmented villonodular synovitis.

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.

Anterior and posterior cruciate ligament rupture after thermal treatment

SUMMARY

This article reports the first published case of spontaneous, simultaneous rupture of both the anterior and posterior cruciate ligaments 3 months after radiofrequency thermal probe treatment. The patient had no previous traumatic injury to the knee. Simultaneous rupture occurred under minimal physiologic load. Clinical, radiologic, and surgical findings are presented.

[Baker's cysts in children. A retrospective study at the hospitals in the county of Rebe from 1992 to 1998]

Popliteal cysts or Baker's cysts in childhood is a rare disease usually found by the parents. The purpose of this study is to study the recurrence rate after primary surgical resection and conservative treatment of the cysts. We retrospectively found 20 children with Baker's cysts treated at Ribe Amts Hospitals during the period 1992-1998. Thirteen patients were treated conservatively and seven had a surgical resection of the cysts performed. Of the 13 conservatively treated patients the cysts was still present in six patients (46%). In seven patients the cysts had disappeared within nine months. In the surgically treated group the cysts recurred in three patients (43%). Surgical intervention for Baker's cysts in children should only be performed after thorough consideration, due to a high recurrence rate.

Long-term follow-up of conservatively treated popliteal cysts in children

This study was undertaken to determine the long-term outcome of conservatively treated popliteal cysts in children. It was based on a review of 20 cysts, none of which were initially treated surgically. The records of children with popliteal cysts between 1986 and 1992 were studied, and a group of patients without other diseases or other physical abnormality in the knee region was selected. Twenty-one patients were included and were subjected to a clinical and ultrasound investigation. Three were lost to follow-up, leaving 18 patients with 20 cysts available for analysis. In the follow-up period, which ranged from 5 to 10 years, 14 cysts were treated conservatively with a mean follow-up of 7 years, whereas 6 cysts were operated on after a mean period of 2 years. Of the conservatively treated cysts, eight had disappeared and six had shrunk. Although spontaneous remission is not to be expected in all cases, asymptomatic popliteal cysts in children can be treated conservatively with good results.

Anterior arthroscopic synovectomy plus capsuloplasty with a pedicle graft for the treatment of rheumatoid popliteal cysts

OBJECTIVE

To assess the value of arthroscopic synovectomy plus capsuloplasty with a pedicle graft in patients with rheumatoid cysts of the knee.

METHODS

We examined 31 rheumatoid knees in 9 men and 22 women with an average age of 52.5 years at time of operation. Postoperative clinical symptoms were investigated in comparison with each factor examined before the operation.

RESULTS

Postoperative results showed that 74% of the patients were grade 0 (no swelling or pain), 23% were grade 1 (swelling and slight discomfort after strenuous work or sports), and 3% were grade 2 (swelling and tenderness after normal activities). The improvement rate of the patients with arthroscopic synovectomy plus pedicle graft capsuloplasty was significantly higher than that of the untreated controls or patients with arthroscopic synovectomy or pedicle graft capsuloplasty. The preoperative degree of joint effusion, acceleration in the erythrocyte sedimentation rate, radiographic grades, and histological activity in the knee joint at the time of operation were correlated with the final clinical symptoms.

CONCLUSION

Our method may be useful for preventing recurrence of rheumatoid popliteal cysts.

Popliteal cysts in children: a retrospective study of 62 cases

Popliteal cysts in children are usually asymptomatic and are usually found fortuitously by the parents. This study presents a series of 62 children with popliteal cysts. Among the 51 patients who received no treatment, the cysts had already disappeared at the time of the study in 43 patients; the remaining 8 patients are under 14 years of age and are without complaints. This study confirms the hypothesis that the primary popliteal cyst in children usually disappears before the age of 18. Surgery presents unnecessary risks for the patient ; moreover, the chance of recurrence after surgery is real.

[Cystic adventitial disease: importance of computed tomography in the diagnostic and therapeutic management]

PURPOSE

Popliteal artery entrapment and adventitial cystic disease are the main causes of claudication in young patients. Adventitial cystic disease is a rare vascular pathology mostly affecting the popliteal artery but other localisations have been reported. Diagnosis and therapeutic management of adventitial cystic disease and particularly percutaneous aspiration are presented.

MATERIALS AND METHODS

The authors report six cases (four men and two women; mean age: 55) of CAD of the popliteal artery (n = 4) and unusual cases in the femoral artery (n = 1) and in the femoral vein (n = 1) explored by sonography, computed tomography (CT), magnetic resonance imaging (MRI) and angiography. Five patients were initially treated by CT-guided aspiration and one with endoprosthesis.

RESULTS

Sonography, CT or MRI are more useful to establish the diagnosis because these techniques can directly visualize the arterial wall. All these patients but one have been treated by percutaneous method with a good functional outcome but surgical intervention was necessary for two of them because of cysts recurrence.

CONCLUSION

Our experience suggests that percutaneous CT-guided aspiration is the first treatment option for small cysts but close long-term follow-up is necessary to detect recurrence.

Proximal dissection of a popliteal giant synovial cyst: a case report

Giant synovial cysts in patients with rheumatoid arthritis are well-recognized soft-tissue masses adjacent to the knee. Cases involving the elbow, hip, and other synovial joints have been reported as well. Regardless of location, these expanding, space-occupying lesions usually present with nonspecific symptoms of swelling and pain. Less commonly, the original presentation may be related to the secondary effects of the cyst on nearby anatomic structures. We present a case of a giant synovial cyst originating posteriorly in the knee, which, rather than dissecting distally into the calf, dissected proximally into the posterior soft tissue of the thigh in a patient with long-standing rheumatoid arthritis.

Benign soft-tissue lesions in children

This article is a review of the common benign soft-tissue lesions of the spine and extremities. Reviewed are the pathophysiology, natural history, appropriate work-up, and treatment options. A recommendation is given to consider the diagnosis as possible malignancy and approach such lesions with caution.

Treatment of cystic lesions of soft tissue using fibrin sealant

A new method was devised for treating 29 patients with cystic lesions of the soft tissue (popliteal cysts, bursitis, and ganglia) by injecting a fibrin sealant into the cyst after the aspiration of the contents. During the followup period (mean, 2.2 years), cysts did not recur in 22 (76%) patients. Of the 7 patients with recurrences, 4 were treated again in the same manner and 3 of these cases have not recurred. Additionally, to investigate the healing process in cysts, fibrin sealant was injected into the space between the abdominal muscle and the peritoneum of rats. Specimens were obtained after the rats were sacrificed at 1, 2, 4, and 8 weeks after injection, and were examined histopathologically. The fibrin sealant was found to be completely resorbed and replaced with organized granulation tissue. In case of multiple failed aspirations to the cystic lesions, this new method is recommended before surgery.

[Pseudothrombophlebitis due to an expansive popliteal cyst associated with Reiter's syndrome]

Popliteal cysts presenting as thrombophlebitis are unusual diseases of the popliteal fossa and are commonly associated with rheumatoid arthritis or meniscal tears. The authors report the case of a 38-year-old man with Reiter's syndrome in which a synovial cyst of the popliteal space, mimicking symptoms suggestive of deep venous thrombosis, complicated the course of the arthritis. Clinical and diagnostic features of this rare popliteal pathology are discussed and the usefulness of noninvasive diagnostic methods for detecting this disease, in particular that of echotomography, is emphasized. The authors stress the importance of a correct diagnosis in order to avoid the risks of an erroneous anticoagulant treatment.

Ethanol injection sclerotherapy for Baker's cyst, thyroglossal duct cyst, and branchial cleft cyst

Six patients with Baker's cysts, 3 with branchial cleft cysts, and 2 with thyroglossal duct cysts were treated with percutaneous aspiration and absolute ethanol sclerotherapy using a 7-French pigtail catheter. Cystography was performed before ethanol injection to confirm that there was no extravasation and that it was a monocystic lesion. One recurrence of a Baker's cyst was revealed in follow-up examinations, which ranged from 11 months to 36 months (mean, 25 months). The major complication of hypoesthesia of the popliteal region was observed in 1 patient treated for Baker's cyst. The results of this series suggest that ethanol sclerotherapy is the treatment of choice for Baker's cyst, branchial cleft cyst, and thyroglossal duct cyst.

[The value of ultrasound for correction of clinical diagnostic errors in soft tissue tumors]

In doubtful clinical diagnosis, ultrasound investigation may represent a workable diagnostic means in revealing the nature of soft tissue alterations, as will be demonstrated by 6 clinical examples; in all cases a wrong clinical diagnosis delayed the necessary therapy and possibly deteriorated the prognosis of disease. In these patients correction of the clinical diagnosis was of decisive importance for consecutive diagnostics and therapy.

[Pseudo-thrombophlebitis syndrome: diagnostic and therapeutic considerations of 2 cases]

Pseudo-thrombophlebitic syndrome is a frequent clinical entity but many times insufficiently diagnosed. Described more than a century ago by Baker it is characterized for being clinically undistinguishable from a true thrombophlebitis, being its cause the presence of a synovial cyst in the knee joint (Baker's cyst) which can be complicated or not (breakage or dissection). Diagnosis is easy and is based mainly in echography and arthrography. The anticoagulant therapy used in true thrombophlebitis is contraindicated in this syndrome.

Baker's cysts, pseudothrombophlebitis, pseudo-pseudothrombophlebitis: where do we stand?

The diagnostic approach and therapeutic attitudes to be assumed when facing the dilemma of deep vein thrombosis versus a complicated Baker's cyst remain unclear. We examined our own approach with 16 Baker's cysts [11 presenting with a "thrombophlebitis picture" (TP)] recently diagnosed in our services, and reviewed the literature. All of our patients had an underlying joint disorder and previous knee effusions. The diagnostic approach (i.e., the request or not for venography) was related to the specialty of the physician who saw the patient first. The results of the venography led to anticoagulation treatment in 5 of the 6 patients on whom it was performed, although these patients did not otherwise differ from those with a similar clinical picture in whom no venogram was obtained. Arthrograms performed early after onset of the TP were more likely to reveal cyst rupture. The recent literature does not mention serious venous complications (in particular, pulmonary embolism) in patients in whom only the cyst was treated, without knowledge of possible coexisting venous occlusions. The need to perform venography, the importance of the localisation of the occlusions and the therapeutic consequences are discussed and a proposal is made to study these patients in a systematic way in order to better understand the inter-relationship between complicated popliteal cysts and venous alterations, and to decide the best approach to assume in the future.