Baker cyst
Baker cysts are most often found incidentally when the knee is imaged for other reasons.
Baker cysts, or popliteal cysts:
- 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.
- Consistency: fluid-filled distended synovial-lined lesions.
- 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:
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
Complications
Recognized complications include:
- dissection
- rupture
- compression of the popliteal vessels and tibial nerve
- compartment syndrome: can be either anterior or posterior
Nicely written...
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