GET THE APP

Baker's Cyst Rupture May Mimics Deep Vein Thrombosis
Emergency Medicine: Open Access

Emergency Medicine: Open Access
Open Access

ISSN: 2165-7548

+44 1223 790975

Editorial - (2012) Volume 2, Issue 1

Baker's Cyst Rupture May Mimics Deep Vein Thrombosis

Antonios G Angoules*
Department of Essential Medical Subjects, Faculty of Healthcare Professions, Technological Educational Institute, Athens, Greece
*Corresponding Author: Antonios G Angoules, Department of Essential Medical Subjects, Faculty of Healthcare Professions, Technological Educational Institute, Athens, Greece Email:

Αlthough the first report on a popliteal cyst was originally reported by Adams in 1840 [1] these cysts were named thirty-seven years later, after Wiliam Baker published his famous paper [2]. Popliteal or Baker’s cysts are abnormal synovial fluid-filled masses located in the popliteal fossa and almost always result in chronic knee joint effusion. The cyst may be a herniation of the gastrocnemius or semimembranosus bursa through the fibrous layer of the joint capsule into the popliteal fossa, communicating with the synovial cavity of the knee joint by a narrow stalk [3]. This communication between the knee joint and one of the popliteal bursae in up to 40% of normal knees has been described [4]. In a recent ultrasonographic evaluation their size varies from 1.4–6.2 cm [5] .

Almost all popliteal cysts may be secondary. These popliteal cysts have a multifactorial etiology but generally they are the final manifestation of intraarticular pathology of the knee joint. They are often associated with osteoarthritis, rheumatoid arthritis, cartilage tears, meniscal tears, and ACL insufficiency and, less commonly, to overuse, infections, trauma, and other causes such as spondyloarthropathy or gout [5-12].

On the other hand in the less numerous primary cysts, a distension of the bursa arises independently with no communication to the joint and no knee derangement [9].

Baker’s or popliteal cysts are the most frequently found soft-tissue masses in the posterior knee [13]. The range of their incidence in series of patient who underwent MRI or ultrasonography of the knee was calculated as high as 5% to 27% and was notably more common in osteoarthritic knees [5,7,14]. Older people present a higher incidence of Baker’s cyst as well [7]. Asymptomatic cysts found incidentally need no treatment. Most symptomatic cysts respond temporarily to intraarticular corticosteroid injections [10]. Surgical excision is needed only in rare cases [9, 15].

The popliteal cyst can compress various anatomical structures such as the popliteal vein which is the most frequently compressed structure. As a secondary complication thrombophlebitis may occur [9]. Rupture of popliteal cyst may resemble Deep Vein Thrombosis (DVT), a pathologic entity known as pseudothrombophlebitis [16-21].

A pseudothrombophlebitis syndrome related to Baker’s cyst rupture is well documented [16-21].

Sometimes sudden swelling and pain in the calf is not the result of DVT, but instead accompanies popliteal cyst ruptures.

The differential diagnosis between DVT and ruptured popliteal cyst is imperative as the first nosologic entity encompasses life threatening risks such as pulmonary embolism. Other pathologies that mimic DVT of the leg such as Baker’s cyst, haematoma, cellulitis, postphlebitic syndrome, extrinsic compression from a popliteal artery or venous aneurysm or a tumour must be excluded from the initial diagnosis [4, 22, 23].

Falsely diagnosed thromboplebitis and use of anticoagulantant treatment may cause cyst haemorrhage [10]. Although an infrequent occurrence, a Baker’s cyst can compress vascular structures and cause leg edema and a true DVT. In the event of cyst rupture, severe pain indicates thrombosis, or muscle rupture, resulting in warmth, tenderness, and redness of the calf. However, the ruptured cyst may be without much pain, with calf and ankle swelling[10].

Ultrasonography is a tool of great value in order to investigate a ruptured cyst in a swollen and painful leg and is both a safe and an inexpensive technique [4, 24].

Cyst rupture may be challenging to identify on Venous Doppler Sonography. Still, sudden onset of calf pain which is elicited by ankle dorsiflexion are findings following Baker’s cyst rupture. Differentiating cyst rupture from a dissecting hematoma may be difficult on ultrasonography. It can be said though that the hematoma consists of a more homogenous pattern[4].

MRI may lead not only to diagnosing popliteal cyst ruptures but may also reveal any concomitant intrarticular pathology.

Treatment of a ruptured Baker cyst mimicking DVT includes symptomatic relief with bed-rest, support, and non-steroidal antiinflammatory drugs. Anticoagulation is contraindicated for a ruptured Baker’s cyst as calf haematomas and muscle contractures may ensue [25].

In conclusion Baker’s cyst rupture mimicking thrombophlebitis must always be considered as a possible diagnosis when symptoms in the calf are experienced.

References

  1. Adams R (1840) Chronic rheumatic arthritis of the knee joint. Dublin J Med Sci 17: 520-522.
  2. Baker WM (1877) On the formation of the synovial cysts in the leg in connection with disease of the knee joint. Clin Orthop Relat Res 13: 245-61.
  3. Moore K, Agur A, Dalley A (2010) Essential Clinical Anatomy. (4th Edn). Lippincott Williams & Wilkins, USA.
  4. Langsfeld M, Matteson B, Johnson W, Wascher D, Goodnough J, et al. (1997) Baker's cysts mimicking the symptoms of deep vein thrombosis: diagnosis with venous duplex scanning. J Vasc Surg 25: 658-662.
  5. Chatzopoulos D, Moralidis, E, Markou P. Makris V, Arsos G (2008) Baker’s cysts in knees with chronic osteoarthritic pain: a clinical, ultrasonographic, radiographic and scintigraphic evaluation. Rheumatol Int 29: 141-146.
  6. von Schroeder HP, Ameli FM, Piazza D, Lossing AG (1993) Ruptured Baker's cyst causes ecchymosis of the foot. A differential clinical sign. J Bone Joint Surg Br 75: 316-317.
  7. Miller TT, Staron RB, Koenigsberg T, Levin TL, Feldman F (1996) MR imaging of Baker cysts: association with internal derangement, effusion, and degenerative arthropathy. Radiology 201: 247-250.
  8. Sansone V, De Ponti (1999) An Arthroscopic treatment of popliteal cyst and associated intra-articular knee disorders in adults. Arthroscopy 15: 368-372.
  9. Fritschy D, Fasel, J. Imbert JC, Bianchi S, Verdonk R, et al.(2006) The popliteal cyst. Knee Surg Sports Traumatol Arthrosc 14: 623-628.
  10. Handy JR (2001) Popliteal cysts in adults: a review. Semin Arthritis Rheum 31: 108-118.
  11. Hill CL, Gale DG, Chaisson CE, Skinner K, Kazis L, et al. (2001 ) Knee effusions, popliteal cysts, and synovial thickening: association with knee pain in osteoarthritis. J Rheumatol 28: 1330-1337.
  12. Ozgocmen S, Kaya A, Kocakoc E, Kamanli A, Ardicoglu O, et al. (2004) Rupture of Baker's cyst producing pseudothrombophlebitis in a patient with Reiter's syndrome. Kaohsiung J Med Sci 20: 600-603.
  13. Insall J, Scott WN (2001) Surgery of the Knee. (3rd Edn) C. Livingstone, Philadelphia.
  14. Fielding JR, Franklin PD, Kustan J (1991) Popliteal cysts: a reassessment using magnetic resonance imaging. Skeletal Radiol 20: 433-435.
  15. Burger C, Monig SP, Prokop A, Rehm KE (1998) Baker's cyst--current surgical status. Overview and personal results. Chirurg 69: 1224-1229.
  16. Bryan RS, DiMichele JD, Ford GL Jr (1967) Popliteal cysts and "thrombophlebitis". Clin Orthop Relat Res 50: 209-213.
  17. Drescher M and Smally A (1997) Thrombophlebitis and pseudothrombophlebitis in the emergency department. Am J Emerg Med 15: 683-685.
  18. Kilcoyne RF, Imray TJ, Stewart ET (1978) Ruptured Baker's cyst simulating acute thrombophlebitis. JAMA 240: 1517-1518.
  19. Gibbons D, Phillips M, Prossor IM (1975) Ruptured popliteal cyst stimulating deep vein thrombosis with false positive radiofibrinogen uptake. Postgrad Med J 51: 735-736.
  20. Prescott SM, Pearl JE, Tikoff G (1978) "Pseudo-pseudothrombophlebitis": ruptured popliteal cyst with deep venous thrombosis. N Engl J Med 299: 1192-1193.
  21. Katz RS, Zizic TM, Arnold WP, Stevens MB (1977) Medicine (Baltimore) 56: 151-164.
  22. Somarouthu BS, Abbara S, Kalva SP (2010) Diagnosing deep vein thrombosis. Postgrad Med 122: 66-73.
  23. de Oliveira A, Franca GJ, Vidal EA, Stalke PS, Baroncini LA (2008) Duplex scan in patients with clinical suspicion of deep venous thrombosis. Cardiovasc Ultrasound 6:53.
  24. Sato O, Kondoh K, Iyori K, Kimura H (2001) Midcalf ultrasonography for the diagnosis of ruptured Baker's cysts. Surg Today 31: 410-413.
  25. Chaudhuri R. Salari R (1990) Baker's cyst simulating deep vein thrombosis. Clin Radiol 41: 400-404.
Citation: Angoules AG (2012) Baker’s Cyst Rupture May Mimics Deep Vein Thrombosis. Emergency Medicine 2:e108.

Copyright: © 2012 Angoules AG. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Top