This Is a Xray (Xray taken after injecting water soluble contrast in to the Knee  Joint)showing the knee joint  of  a man who was  complaining sudden onset of calf pain and swelling of the Calf ,  after came home finishing his works.Since 2 months back , before the onset of calf pain he has had some tightness behind the knee and paresthesia of the feet.
His Back of  the knee joint was  swallen,tender and reddish.

Identify this Xray?
What is your Diagnosis?






ANSWER



RUPTURED BAKER'S CYST(PSEUDOTHROMBOPLEBITIS SYNDOME)
Baker's cyst(popliteal cyst), a collection of synovial fluid which has escaped from the knee joint or a bursa and formed a new synovial-lined sac in the popliteal space.The term 'cyst' is a misnomer because it is in fact a synovial sac bulging from the back of the joint.Baker's cysts arise between the tendons of the medial head of the gastrocnemius and the semimembranosus muscles.

CAUSES

It can be caused by virtually any cause of arthritis
Eg : Osteoarthritis, juvenile arthritis of the knee, rheumatoid arthritis
Baker's cysts can be associated with Lyme disease also.
Cartilage (particularly the meniscus) tear

CLINICAL FEATURES

Asymptomatic or asssociated with knee joint pain tightness behind the knee, especially when the knee is extended or fully flexed
If it is large it becomes palpable particularly on standing ,soft and minimally tender
Ruptured Baker's cyst can produce acute pain behind the calf and knee,redness and swelling of the calf that may mimic thrombophlebitis or a potentially life-threatening deep vein thrombosis (DVT)

INVESTIGATIONS

  1. Diagnosis is confirmed by Ultrasonography
  2. Arthrogram
  3. MRI

TREATMENT

  1. Rest and leg elevation
  2. Removal of excess knee fluid in conjunction with cortisone injection.
  3. Surgical excision is reserved for cysts that cause a great amount of discomfort to the patient



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11 comments

  1. Anonymous Says:
  2. Baker Cyst Ruptured

     
  3. Anonymous Says:
  4. ruptured baker cyst....

     
  5. It is easy and so direct ..

    Ruptured baker cyst ..

     
  6. Anonymous Says:
  7. Contrast extravasation in the upper claf,,, most likely cause is from a rupture Baker cyst. Long standing mild symptoms suggests its presence.

    anm

     
  8. Admin Says:
  9. Answer - Ruptured Baker's Cyst results in Pseudothrombophlebitis syndrome. Rupture of a popliteal cyst causing leakage of synovial fluid, leading to inflammatory irritation to the gastrocnemius muscle.

    Complications of Ruptured Baker's Cyst - compartment syndrome in the calf

     
  10. This comment has been removed by the author.  
  11. X-ray interpretation:
    dissection of fluid into the adjacent proximal gastrocnemius muscle belly.

    Diagnosis: Baker Cyst rupture.

     
  12. Anonymous Says:
  13. contrast extravasation due ruptured baker's cyst

     
  14. Appreciate if you add a detailed descrription on every case each time.
    Thanks a lot.

     
  15. Anonymous Says:
  16. i like the way the answers are given this time thanks

     
  17. Nice blog you have here about a sudden onset of calf pain and swelling. Topics such as this is very interesting especially on how to treat it because this is very common especially among people living a very active lifestyle.

     

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