Abstract
We report a case of a 75-year-old female with a history of acute deep vein thrombosis (DVT) 6 years ago who presented with unilateral calf swelling and pain. D-dimer was normal, and compression ultrasound revealed findings typical of DVT, including an incompressible dilated and hypoechoic peroneal vein. Despite 4 months of anticoagulation for supposed recurrent DVT, pain symptoms persisted and repeat D-dimer and compression ultrasound were unchanged. A magnetic resonance imaging scan to investigate the leg demonstrated a 6-cm dissecting Baker’s cyst extending posterolaterally resulting in venous compression and distal dilation, which appeared to have been confused with a DVT. Ultrasound-guided aspiration of the cyst provided immediate and sustained relief. Herein we provide a review of the literature for the management of this rare scenario.
Highlights
The differential diagnosis for a unilateral swollen, painful lower extremity includes but is not limited to deep vein thrombosis (DVT), arterial insufficiency, Baker’s cyst rupture, hematoma, lymphedema, thrombophlebitis, thromboangiitis obliterans, venous stasis dermatitis, popliteal aneurysm rupture, neural tumor, malignant histiocytoma, varicose veins, and cellulitis.[1,2] Most of these diagnoses carry additional identifying features aiding in their recognition, such as characteristic symptoms or skin changes
DVT and ruptured Baker’s cysts are well known to be clinically indistinguishable, and the latter should be kept in mind when managing these patients emergently, as the initial diagnostic approach is the same, but treatment and complications are very different.[3,4]
We report a case of an intact complicated Baker’s cyst both clinically and radiologically mimicking a recurrent DVT
Summary
The differential diagnosis for a unilateral swollen, painful lower extremity includes but is not limited to deep vein thrombosis (DVT), arterial insufficiency, Baker’s (popliteal) cyst rupture, hematoma, lymphedema, thrombophlebitis, thromboangiitis obliterans, venous stasis dermatitis, popliteal aneurysm rupture, neural tumor, malignant histiocytoma, varicose veins, and cellulitis.[1,2] Most of these diagnoses carry additional identifying features aiding in their recognition, such as characteristic symptoms or skin changes. Prior medical records indicated a positive D-dimer at 1.21 mg/L and acute thrombus on CUS in 2008, for which she received 6 months of anticoagulative therapy. Based on this and her continued estrogen intake, a recurrent ipsilateral DVT was suspected. Magnetic resonance imaging to evaluate the Baker’s cyst revealed extension of the cyst inferolaterally as a lobulated ganglion/ synovial cyst dissecting along the lateral margin of the medial head of the gastrocnemius muscle, without evidence of DVT (Figure 1) This was confirmed on magnetic resonance angiogram, demonstrating patent vasculature with no clear-cut filling defect. This yielded 3 mL of straw-colored, blood-tinged, nonpurulent fluid and provided immediate and sustained relief
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