Ruptured Baker's Cyst

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Ruptured Baker's Cyst

Authors, Editors, Case Information Author: Ashley Best, MD Affiliation: University of Iowa Sports Medicine, Iowa City, IA Co Author(s): Ben Kopecky, DO, MS , Mederic Hall, MD Senior Editor: Nicholas Moore, MD Clinical Vignette: A 64-year-old male presented with 3 months of left knee pain and swelling after sustaining a work injury. The patient reported swelling in the back of the knee with a fullness sensation down his calf into the ankle. Exam was notable for swelling in the posterior knee, lateral joint line tenderness to palpation, and pain with knee hyperflexion. Type of Probe Used: 14-5 MHz High Frequency Linear Transducer Unlabeled Short Axis View of the Posterior Knee Unlabeled Short Axis View of the Posterior Knee Labeled Short Axis View of the Posterior Knee Labeled short axis view of the posterior knee showing a hypoechoic fluid collection consistent with a Baker's cyst with the stalk of the Bakers cyst (white arrow) between the medial head of the gastrocnemius (MG) and the semimembranosus (SM). Unlabeled Short Axis View of the Posteromedial Knee with Doppler Unlabeled Short Axis View of the Posteromedial Knee with Doppler Labeled Short Axis View of the Posteromedial Knee with Doppler Labeled Short Axis View of the Posteromedial Knee with Doppler, showing anechoic cystic appearing fluid collection without internal or peripheral Doppler flow Unlabeled Extended Long Axis View of the Posterior Leg Unlabeled Extended Field of View Long Axis View of the Posterior Leg Labeled Extended Long Axis View of the Posterior Leg Labeled Extended Field of View Long Axis View of the Posterior Leg showing the fluid of the ruptured Bakers cyst (white arrows) extending inferiorly in the fascial plane superficial to the medial gastrocnemius muscle (MG). #7 - Video View Video Short Axis Dymanic Compression View of the posterior knee demonstrating the non-compressibility of the Baker’s cyst. Interpretation Image Interpretation: Tissue-fluid interface between the left semimembranosus tendon and medial gastrocnemius tendons consistent with a Bakers cyst. The cyst contents extend distally into the medial gastrocnemius superficial fascia supporting a diagnosis of a ruptured Bakers cyst. The longitudinal extension of the remaining cyst measures approximately 7.43 cm. Teaching Pearl: Bakers cysts can occur in approximately 30% of patients with symptomatic knee osteoarthritis but can also be caused by acute injuries to chronic meniscal tears as seen in this case. They are pathognomocially found between the distal semimembranosus and proximal medial gastrocnemius tendons. The symptoms of Bakers cyst ruptures can overlap with other pathologies, such as pseudothrombophlebitis, as they both can present with acute calf pain, swelling, and warmth/erythema. These symptoms can further mimic deep venous thrombosis, therefore making ultrasound a first line imaging modality to delineate between these pathologies. This case demonstrates the classic ultrasound findings of a ruptured Bakers cyst including a stalk of the cyst in the classic anatomic location with associated fluid dissection of the muscle and fascial layers distal to the popliteal fossa. References: Hill CL, Gale DR, Chaisson CE, et al. Periarticular lesions detected by magnetic resonance imaging: prevalence in knees with and without radiographic osteoarthritis. Arthritis Rheum. 2003;48(10):2836-2844. doi:10.1002/art.11284. Katz RS, Zizic TM, Arnold WP, Stevens MB. The pseudothrombophlebitis syndrome. Medicine (Baltimore). 1977;56(2):151-164. Smith MK, Lesniak BP, Baraga MG, Kaplan LD, Jose J. Baker and baker-like cysts of the knee: a review. Sports Health. 2015;7(4):359-365. doi:10.1177/1941738113520134
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Authors, Editors, Case Information

Unlabeled Short Axis View of the Posterior Knee

Labeled Short Axis View of the Posterior Knee

Unlabeled Short Axis View of the Posteromedial Knee with Doppler

Labeled Short Axis View of the Posteromedial Knee with Doppler

Unlabeled Extended Long Axis View of the Posterior Leg

Labeled Extended Long Axis View of the Posterior Leg

#7 - Video

Interpretation

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