Abstract
A Baker's cyst is usually an incidental finding in adults being investigated for a joint arthropathy, and its rupture preceding the diagnosis of juvenile idiopathic arthritis (JIA) is rare in children. Here, we describe a case of a 4-year-old girl who presented to the Emergency Department with right calf pain, swelling, and no preceding history of trauma. MRI confirmed a ruptured Baker's cyst with inflammatory arthropathy alongside an extensive synovial proliferation throughout the knee joint with large joint effusions and associated soft tissue oedema tracking superiorly and inferiorly along the medial head of gastrocnemius and anteriorly along the tibia. Further investigations revealed bilateral uveitis consistent with a diagnosis of juvenile idiopathic arthritis.
Highlights
A Baker’s cyst is a mass located in the popliteal area, filled with fluid [1]
There are very few cases of paediatric patients with a first presentation of knee swelling and pain in the context of juvenile idiopathic arthritis (JIA) [11], whereas in the adult population it is more likely that a popliteal cyst will present with arthritic conditions or internal derangement within the knee joint
There are very few cases of paediatric patients with a first presentation of knee swelling and pain in the context of JIA [10], whereas in the adult population it is more likely that a popliteal cyst will present with arthritic conditions or internal derangement within the knee joint
Summary
A Baker’s cyst (or popliteal cyst) is a mass located in the popliteal area, filled with fluid [1] An extension of this is the synovial popliteal cyst: a communication of the gastrocnemius and semimembranous bursa with the posterior joint capsule [2]. A rupture within this communication causes fluid to drain down, resulting in calf swelling. Calf pain and swelling as clinical presentation for a ruptured Baker’s cyst in the setting of a JIA is rare. There are very few cases of paediatric patients with a first presentation of knee swelling and pain in the context of JIA [11], whereas in the adult population it is more likely that a popliteal cyst will present with arthritic conditions or internal derangement within the knee joint. We describe a toddler who presented with a right calf swelling following a ruptured Baker’s cyst, demonstrating the diagnostic challenges and highlighting a high index of suspicion in this age group
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