Baker cyst

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Baker cysts are most often found incidentally when the knee is imaged for other reasons.

 Baker cysts, or popliteal cysts:
  1. Location: They are usually located at or below the joint line; arising in the popliteal fossa between the medial head of the gastrocnemius and the semimembranosus tendons that communicates with the knee joint.  They occur as a communication between the posterior joint capsule and the gastrocnemius-semimembranosus bursa, resulting in fluid being squeezed in one direction.
  2. Consistency: fluid-filled distended synovial-lined lesions.
  3. They are not a true bursa nor a true cyst. 
They are seen between 4-7 years and in adults above 35 years.
Differential diagnosis: 
DVT: Symptomatic presentation may be acute when rupture occurs, in which case the chief differential diagnosis is deep venous thrombosis. 
Mass: A chronic/subacute presentation can manifest as a popliteal fossa mass or with pain.

 Ultrasound: Normally the first line investigation:
  • well-defined cyst with a 'neck' at its deepest extent, extending into the joint space between the semimembranosus tendon and the medial head of the gastrocnemius
  • identification of a fluid-filled structure at the posteromedial knee is suggestive of a popliteal cyst, but identification of the 'neck' between the tendons is necessary for a definitive diagnosis
  • usually anechoic, but may contain internal debris
Recognized complications include:
  • dissection 
  • rupture 
  • compression of the popliteal vessels and tibial nerve
  • compartment syndrome: can be either anterior or posterior

Comments

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    Nicely written...

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