Baker's Cyst Research Articles

The Updated Role of Ultrasound in the Assessment of Knee Osteoarthritis

Abstract Background Osteoarthritis (OA) of the knee is the most common form of knee arthritis and a leading cause of chronic disability. Objective The aim of the current study is to reassess the utility of the updated ultrasound in the patients with knee osteoarthritis and outline its clinical application. Patients and Methods The studied group included 36 patient 23females and 13 males with their ages ranged between 39 and 58 years (average age 44 years). The patients were referred to US examination fulfilling the ACR clinical criteria for knee OA after orthopedic and /or rheumatologist consultation. The study was performed in Radiodiagnosis department Ain Shams University Hospitals (20 patients ) and at one private center (16 patients). Results There was a discrepancy between the results obtained by clinical examination and those demonstrated by ultrasonography. Clinical examination detected 22 (61.1%) of our cases. Prevalence of US findings in our cases were femoral articular degeneration in 28 (77.7%) patients, Tibiofemoral osteophytes were seen in 26 patients (72.2%), knee effusion in 22 patients (61.1%),meniscal extrusion in 22 patients (61.1%) meniscal degeneration in 17 patients (47.2%) and synovial hypertrophy in 15patients (41.6%). Baker’s cysts were demonstrated in 14patients (38.8%) while pes anserine syndrome was demonstrated in 4 cases. Meniscal degeneration and meniscal extrusion were correlated significantly with femoral cartilage degeneration (P<.001). Although knee effusion did not correlate with advanced knee effusion did significantly (P > 0.05). Baker's cysts is statistically related to the presence and severity of mensical changes and also related to the degree of femoral articular cartilage degeneration. Conclusion US is a valuable technique that can assess soft tissue structures within the knee and their involvement in the osteoarthritic process .US enables in guiding and monitoring therapy through detection of knee structural damage.

UNUSUAL PRESENTATION OF AORTIC DISSECTION WITH RIGHT CALF PAIN

TOPIC: Cardiothoracic Surgery TYPE: Medical Student/Resident Case Reports INTRODUCTION: The incidence rate of acute type A aortic dissection is between 2.1 and 16.3 per 100,000 persons per year. Over 90% of patients with acute aortic dissection present with chest or back pain. In the case of an acute dissection, mortality can be almost 50% within the first 48 hours of symptom onset, 21 to 49% of the patients with aortic dissection die before reaching the hospital. Therefore, prompt diagnosis and treatment is imperative for survival. Aortic dissection can be easily missed in the settings of atypical presentation. We are presenting a case of a 48-year-old male who presented with right calf pain as a symptom of acute aortic dissection. CASE PRESENTATION: The patient is a 48 year old male with no known medical history presented with chief complain of right calf pain. He woke up from his sleep due to severe throbbing pain in his right calf that radiated to the calf with associated paresthesia. He denied recent trauma, prolonged period of immobilization, recent travel, known history of Baker's cyst, insect bites or exertion. Upon further questioning, the patient did report chronic back pain. Vitally, his blood pressure was elevated at 216/126 with no significant difference between both arms, no tachycardic, and not hypoxic. Clinically, his right lower calf is swollen with tortuous vein, not tense. Distal pulses are palpable with a sensory deficit at the dorsum of the right foot. Laboratory studies were only significant of a D-dimer of 32,279. Due to the elevated D-dimer, CTA chest and abdominal CT Aorta/Iliofemoral angiography was obtained that revealed an acute Stanford type A dissection of the thoracoabdominal aorta, large fusiform dissecting aneurysm of the distal abdominal aorta extending into bilateral common iliac arteries with absent distal runoff enhancement to the right foot, indicative of critical limb ischemia. An esmolol drip was quickly started and transferred to high-level care facility for an emergent surgical procedure. DISCUSSION: Our patient presented with an acute right leg pain that prompted us to get a D-dimer to further evaluate for an acute deep venous thrombosis. An elevated D-dimer has been found to have 96.7% sensitivity for aortic dissection, the significantly elevated d-dimer levels prompted an emergent CTA of the chest and abdomen for evaluation of dissection. This case was not considered "text book," since patient did not complain of the typical "tearing" chest pain radiating to the back to be concerned aortic dissection. CONCLUSIONS: Aortic dissection is a life-threatening disease, immediate evaluation can save a patient's life. Since many of these cases are often missed due to atypical presentation, it is imperative to develop awareness regarding the various ways an acute aortic dissection can disguise itself as. This case elucidates the importance of critical limb ischemia and a significantly elevated D-dimer due to an acute aortic dissection. REFERENCE #1: Inga H. Melvinsdottir, Sigrun H. Lund, Bjarni A. Agnarsson, Kristinn Sigvaldason, Tomas Gudbjartsson, Arnar Geirsson, The incidence and mortality of acute thoracic aortic dissection: results from a whole nation study, European Journal of Cardio-Thoracic Surgery, Volume 50, Issue 6, December 2016, Pages 1111–1117, https://doi.org/10.1093/ejcts/ezw235 REFERENCE #2: Wundram, M., Falk, V., Eulert-Grehn, JJ. et al. Incidence of acute type A aortic dissection in emergency departments. Sci Rep 10, 7434 (2020). https://doi.org/10.1038/s41598-020-64299-4 DISCLOSURES: No relevant relationships by Mary Dickow, source=Web Response No relevant relationships by Padmini Giri, source=Web Response No relevant relationships by Verisha Khanam, source=Web Response No relevant relationships by Sarwan Kumar, source=Web Response

A Case Of A Swollen Leg

HISTORY: Patient is an 83 year old female with a history of hypertension and hyperlipidemia that originally presented to vascular clinic with 7 months of left lower extremity swelling and numbness. At that time, she first noticed numbness in her left foot that extended up to mid calf. She also mentioned that in particular, her 3rd, 4th, and 5th toes felt numb and it made it difficult to walk. She denied any injuries to her left lower leg. PHYSICAL EXAMINATION: General: Well appearing in no acute distress, AO x 3. Right knee exam: Normal. Left knee exam: Mild swelling in popliteal fossa. Normal ROM of left knee. No tenderness to palpation along joint lines. Left lower extremity: 1+ edema present to the knee, bluish discoloration of toes on left foot. Unable to fan out 3rd, 4th, and 5th digit. No tenderness to palpation. Right lower extremity: Normal exam DIFFERENTIAL DIAGNOSIS: 1. Popliteal artery/nerve entrapment. 2. Peroneal nerve dysfunction. 3. Baker's cyst causing compression. 4. Cystic adventitial disease. 5. DVT. 6. Arterial thrombosis. 7. Popliteal fossa mass. TEST AND RESULTS: ABI @ DP was 0.37 indicating severe occlusive disease. ABI @ PT was 0.44 indicating severe occlusive disease. MRI revealed extensive cystic structure which occluded a short portion of popliteal artery. FINAL WORKING DIAGNOSIS: Cystic adventitial disease resulting in compression/occlusion of popliteal artery. TREATMENT AND OUTCOMES: We saw this patient in sports clinic to discuss ultrasound guided aspiration of the cyst that was compressing popliteal artery. Initial procedure resulted in removal of 5 cc of thick, gelatinous fluid that was identified as a sparse mucoid matrix. During the procedure, we were able to watch the popliteal artery begin pulsing again. Patient was able to move toes and had improved sensation immediately after procedure. Fatigue in left lower leg has been slowly improving. Plan is to repeat aspiration in an attempt to fully drain entire cystic structure.

Popliteal Vein Aneurysm Masquerading as a Baker's Cyst Leading to Pulmonary Embolism

A 17-year-old female patient had developed a spongy, painless swelling in the right popliteal fossa in 2016. She had never sustained trauma to the right knee. Physical examination had revealed a soft, non-tender lump at the back of the right knee. There was no erythema or warmth and no clinical knee joint effusion. She also had free range of knee joint movement, with no calf swelling.

Arthroscopic cystectomy for Baker's cysts with and without one-way valve lesions: incidence of one-way valve lesion, associated pathologies, and clinical outcomes.

A one-way valve lesion plays an important role in the formation of Baker's cysts and serves as an important landmark for accessing these cysts during arthroscopic surgery. This study aimed to investigate the incidence of one-way valve lesions and their effect on clinical outcomes in patients who underwent arthroscopic cystectomy for Baker's cysts. Patients who underwent arthroscopic cystectomy for Baker's cysts between June 2005 and November 2017 were retrospectively reviewed. Patient demographic characteristics, radiologic/arthroscopic findings (presence of one-way valve lesions, concurrent chondral and meniscal lesions, and cyst wall thickness), and clinical outcomes (clinical recurrence rate, Lysholm score, and complications) at the 2-year follow-up were evaluated. Subgroup analysis was performed to compare clinical outcomes between patients with and without one-way valve lesions. Thirty patients (mean age, 57.4 ± 9.4years) were included in this study. One-way valve lesions were surgically documented in 11 patients (36.7%). Ten patients (33.3%) had chondral lesions with an International Cartilage Repair Society grade ≥ 3, and 23 patients (76.7%) had concurrent chondral and meniscal lesions. At the 2-year follow-up, none of the patients had experienced clinical recurrence; the mean Lysholm score was 76.3 ± 17.5 (48-100). Three patients reported persistent pain, while two reported numbness or paresthesia. Subgroup analysis showed no significant differences in clinical recurrence rates, Lysholm scores, and complication rates between the groups. The incidence of one-way valve lesions during arthroscopic cystectomy for Baker's cysts was lower than that previously reported. Arthroscopic cystectomy showed good clinical results in patients with and without these lesions.

Role of ultrasonography in evaluation of knee osteoarthritis

Objective To evaluate the role of ultrasonography (US) in assessing knee osteoarthritis (OA) compared with radiograph. Background Similar to renal or cardiac failures, OA is considered a common disorder in the joint as an organ. High-resolution US is used increasingly in musculoskeletal medicine owing to its value in the morphological and structural assessment of soft tissue in patients with arthritis. Patients and methods This study included 50 symptomatic knee joints from 50 patients (male/female24 / 26) with the clinical diagnosis of OA; all of them had knee pain and/or swelling. All patients underwent US examination on their knees. Weight-bearing anteroposterior and lateral knee radiographs were assessed for the Kellgren and Lawrence grading along with the potential presence of patellofemoral degenerative signs. Results US findings showed irregular articular surface and narrow joint space (72.0%), marginal osteophytes (64.0%), joint effusions (88.0%), decreased cartilage thickness (32.0%), synovial thickening (20.0%), meniscal lesions (70.0%), Baker's cyst (20.0%), and ligament and tendon injury (24.0%). Soft tissue changes could not be detected in radiograph (0.0%) but were identified clearly by the US in our study, with P value less than 0.001. Joint effusion, which was detected in 44 (88.0%) knees in the US only was detected in six (12.0%) knees in radiograph, with a P value less than 0.001. Kellgren and Lawrence grades (1–3) showed an increased incidence of joint effusion and meniscal lesion in the US, where all the grade 3 cases showed joint effusions and meniscal lesions. Conclusion US is a simple and reproducible technique for the assessment of periarticular and intra-articular abnormalities involved in the pathophysiology of knee OA.

POPLITEAL CYSTIC SCHWANNOMA MIMICKING BAKER CYST – AN UNUSUAL CASE PRESENTATION – CASE REPORT

Introduction: Schwannoma is the most common tumor of peripheral nerves. They are usually solitary, encapsulated, homogenous slow growing masses, sometimes associated with pain and paresthesia.We present a case of schwannoma in an unusual location. Case presentation: A 16 year old boy presented to surgical OPD with a slow growing left popliteal swelling for 6 months and neuralgia for 1 month. The swelling decreasing on knee exion. Based on clinical suspicion patient was operated for popliteal cyst. Intraoperatively there was close association with nerve and it was difcult to dissect from nerve. So it was thought of being a nerve tumor. Surgical excision was done. Histopathological examination revealed it to be Cystic Schwannoma. Discussion: Schwannoma is the most common benign neoplasm of peripheral nerves. Cystic degeneration and repeated hemorrhages (10%) can occur sometimes. There are two types of tissues in Schwannoma – Antoni A and Antoni B.Schwannoma varies from 2-20 cm in diameter. It is not localized to any specic area; it can occur anywhere along peripheral nervous system in neck, mediastinum, retroperitoneum, pelvis, upper extremities. It is extremely unusual in lower limb of which tibial nerve is uncommon site. Conclusion: Diagnosis of schwannoma originating from lower extremity peripheral nerves may be delayed because it can be misdiagnosed as Baker's Cyst or the symptoms of the patient can be thought as a result of lumbar disc herniation.Thorough clinical examination and investigations, conrms the diagnosis, as management is different for both.

Interpretation of the Common MRI Findings in Patients with Painful Knee Joint

Nowadays knee joint pain is a major public health issue and for an appropriate treatment option, it is important to have a clear understanding of the cause of pain as well as to identify the exact location of the pain. In the initial evaluation of acute knee pain, radiological findings help physicians in taking decisions regarding appropriate treatment. Besides conventional radiography and computed tomography (CT), Magnetic resonance imaging (MRI) is often used to diagnose the reason for knee problems. This study it is tried to evaluate the common MRI findings in patients with painful knee joints. The sample population comprised 77 outpatients had an age range between 14 to 66 years, representing male 70.13% and Female 29.87%. The study shows that the maximum numbers of patients were in the 26-30 years age group, which exposed that young people are more affected with knee pain. In this study, it is found that joint effusion is the most common pathology frequently found in 59.74% of patients followed by meniscus injury 53.24%, anterior cruciate ligament (ACL) tear 36.06%, Lateral meniscus injury 16.88%, Posterior cruciate ligament (PCL) tear 7.8%, Bone marrow contusion 22.07%, Osteoarthritis12.98%, Medial collateral ligament (MCL) injury 3.89%, Lateral collateral Ligament (LCL) 0%, Fracture 6.49%, Chondromalacia1.3%, Baker cyst 1.3%. Though knee pain can be diagnosed by other imaging modalities, MRI can often provide strong evidence to support one.

Baker\u2019s cyst in children: conservative management versus surgical excision according to clinical and imaging criteria

BackgroundPediatric patients rarely exhibit Baker’s cysts. This study was conducted on 15 cases (9 males, 6 females) presented with Baker (popliteal) cyst in the last 2 years (from September 2017 to September 2019). The mean age was 8.5 years. The aim of this study was to present our experience in management of these cases based on clinical and imaging criteria. Plain x-ray and knee ultrasonography were routinely done for all cases. If the size of the cyst was less than or equal to 3 cm by ultrasonography, with no or minimal pain, the patients were managed conservatively and were scheduled to followed up visits after 3 months, 6 months, and after 12 months for clinical assessment of symptoms and sonographic size of the cyst. Surgical excision of the Baker’s cyst was considered if the size of the cyst was more than 3 cm with persistent of pain.ResultsSeven cases had cysts less than 3 cm by ultrasonography and were managed conservatively. In five out of these seven cases, the cysts disappeared with no recurrence within the first year of follow-up. In two cases, the cysts increased in size with increase in pain. These two cases were subjected to surgical excision after 1 year of follow-up.The remaining eight cases had cysts more than 3 cm and were managed by surgical excision.Out of the ten cases which were managed by surgical excision, recurrence occurred in 3 cases within the first post-operative year (after 4 months, 7 months, and 8 months) consecutively.ConclusionsThe management of Baker’s cysts in children is debatable, with no definite protocol. In this current study, we conclude that surgical excision of large Baker’s cysts (more than 3 cm) with persistent symptoms is crucial providing meticulous dissection without rupture of the cyst and proper closure of the pedicle which connects the cyst with the knee joint, while conservative management and follow-up is effective in small Baker’s cysts (less than 3 cm) with no recurrence.

Histomorphological changes in baker’s cyst tissues associated with the duration of one-directional thermal exposure

AIM: To identify and describe micro- and ultrastructural thermally induced changes in Bakers cyst wall associated with the duration of unidirectional uniform heating at 70C.
 MATERIALS AND METHODS: We took one full-thickness fragment from each of the 15 Bakers cysts excised during the operation and divided each fragment into four parts: one was used as a control sample, and the remaining three fragments were placed with the synovial membrane on a thermostat heated to 70C, with exposure times of 60, 120, and 180 seconds. We used light-optical and electron microscopes for the histomorphological examination of the samples.
 RESULTS: Two layers of Bakers cyst wall were identified: inner (synovial) and outer (fibrous). In samples exposed to heat for 60 seconds, the synovial layer was undamaged. In samples exposed to heat for 120 seconds, thermal damage to the cells of the synovial layer and underlying collagen fibers of the fibrous layer was evident. With a heating duration of up to 180 seconds, histomorphological examination revealed signs of damage reaching the middle of the fibrous layer, and signs of deep disorganization of the collagen fibers of the cyst wall were determined at the electron-microscopic level.
 DISCUSSION: Using light microscopy of intact sections of the cyst wall, we, like other researchers, identified two layers (synovial and fibrous) of different densities, with blood vessels passing through them. The performed experiment suggests that a clinically significant result using Bakers cyst thermotherapy is achieved when spreading the zone of irreversible coagulation beyond the middle of the fibrous layer of the cyst wall. This, in turn, guarantees damage to the capillary network that provides trophism and proliferation of synoviocytes. The proposed hypothesis corresponds to the paradigm of similar studies on the coagulation of cysts of other localizations.
 CONCLUSION: The obtained results of the light-optical and electron-microscopic examination of Bakers cyst wall fragments indicate direct dependence of the depth of thermal coagulation on the duration of heating.

The common peroneal nerve schwannoma: A case rare case report with brief review of literature

Swelling in popliteal region is a common presentation with usual differential diagnosis of bakers cyst, ganglionic cysts. Schwannoma of common peroneal nerve although a clinically rare entity may also have similar presentation. The treatment of choice for such schwannoma is surgical excision with preservation of nerve integrity. Without knowledge of this consideration and disrespecting nerve planes during surgery may have devastating complications. We here present a similar rare case report of common peroneal nerve schwannoma with brief review of literature; the case was managed by complete surgical excision with no neurological deficit in post operated phase. Keywords: Common peroneal nerve, Schwannoma, Neurilemmoma.

Acute Deep Vein Thrombosis and Association with Popliteal Fossa (Baker's) Cysts in Patients with Lower Extremity Duplex Ultrasound Examination

Background: Popliteal fossa cysts (PFCs aka Baker's cysts) are synovial cysts of the knee joint that can be symptomatic or asymptomatic and incidentally identified on ultrasound. Whether PFCs are associated with deep vein thrombosis (DVT) is unknown. Possible mechanisms for an association include direct compression of the popliteal vein, indirect compression on the popliteal vein with leg flexion, adjacent inflammation of the cyst, or relative immobility due to underlying joint disease itself. Methods: Lower extremity venous Duplex ultrasound radiology reports from the inception of electronic archiving through 11/14/2019 were evaluated across the Mayo Clinic Enterprise (Rochester MN, Jacksonville, FL, Scottsdale AZ, and Mayo Clinic Health System) in patients >18 years of age. Natural language processing (NLP) algorithms were created and validated to identify acute DVT (proximal or distal) and PFCs. A random sample of 1,752 ultrasound reports underwent manual review to calculate the sensitivity and specificity of the NLP algorithm. Cases (ultrasounds with acute DVT) were compared to controls (ultrasound without acute DVT) to examine the frequency of PFCs. IRB approval was obtained and patients lacking Minnesota research authorization were excluded. Results: A total of 332,016 lower extremity venous ultrasounds were performed in 223,035 patients; 156,846 unilateral and 175,170 bilateral lower extremities exams. The mean age at ultrasound was 63.3 (SD 16.5) and 54.7% were female. Ultrasound reports were available for analysis starting in 1992 with a significant increase in the number of ultrasounds performed over the study period across the enterprise (Figure 1). Overall, acute DVT was identified in 24,179 (7.3%) of ultrasounds, and PFCs were identified in 32,427 (9.8%) of ultrasounds. The sensitivity and specificity of the NLP algorithm in the full dataset to identify acute DVT was 86.0% and 97.2%, respectfully. The sensitivity and specificity of the NLP algorithm to identify PFCs was 97.8% and 99.5%, respectively. PFCs were present in 9.3% of ultrasounds with acute DVT and 9.8% of ultrasounds without acute DVT (p=0.007), OR 0.94 (95% CI 0.90-0.98). In a multivariate logistic regression model, after adjusting for age and sex, results remained significant (aOR 0.95, 95% CI 0.91-0.995). Comparing ultrasounds before and after 2010, there was a higher percentage of PFCs and acute DVT reported after 2010 (p<0.001 for both). Sensitivity analyses comparing results before or after 2010, by sex, and only in the first ultrasound performed per person, demonstrated similar results. Conclusions: PFCs are negatively associated with the presence of acute DVT on lower extremity venous Duplex ultrasound. This data does not support PFCs as a contributing or causative factor in the development of lower extremity DVT. Figure 1 Disclosures No relevant conflicts of interest to declare.

Tuberculous Arthritis of Knee Presenting as Baker’s Cyst: A Case Report

Background: Baker's cyst is usually degenerative in origin, infective etiology is rare and tubercular origin is exceptional. Tuberculosis (TB) of the musculoskeletal system is an uncommon infection caused by tuberculous bacilli and constitutes 1% - 5% of all forms of TB. About 30% of skeletal TB involves the joints, the knee being the 3rd most commonly affected after the spine and the hip. Knee tuberculosis commonly presents as synovitis or arthritis. We are presenting a case of a young female with clinico-radiological features suggestive of Baker's cyst. Complete excision of Baker's cyst and histopathology was done. Histopathological examination revealed multiple epitheloid granulomas pointing toward a tubercular etiology. Standard ATT protocol with rehabilitation was followed. The patient was asymptomatic at 1st year with complete resolution of symptoms and full range of motion. This case highlights the need to maintain high index of suspicion in cases hailing from endemic region with unusual intra-operative findings; also, the importance of routine histopathological examination.
 Delta Med Col J. Jul 2020;8(2): 101-104

Assessment of knee osteoarthritis by ultrasonography and its association with knee pain.

Pain is a significant cause of disability in knee osteoarthritis. Conventional radiography is widely used in the assessment of knee osteoarthritis, however radiographic findings do not correlate well with pain. Ultrasonography can be used to evaluate the soft tissue structures of the knee that can be related to pain. To evaluate pain-related soft tissue structures of the knee with ultrasonography. This cross-sectional study included a total of 198 knees from 99 patients with knee osteoarthritis. Knee pain and functional status were evaluated by performing visual analogue scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). On the ultrasound, cartilaginous thickness, knee effusion and presence of Baker's cyst were assessed and the correlation to pain was investigated. Baker's cyst was significantly more frequent in symptomatic knees (13.9%) compared to asymptomatic knees (2.5%). Patients with Baker's cyst had a significantly more limited degree of knee flexion, significantly higher resting VAS pain scores and worse WOMAC scores compared to patients without Baker's cyst. In log-linear analysis, presence of Baker's cyst increased the risk of pain by 2.94 times. Ultrasound as a modality that is easily accessible, inexpensive and without radiation exposure is helpful to demonstrate factors related to pain in knee osteoarthritis by allowing assessment of soft tissue structures.

Causes of Pain in Knee Osteoarthritis

Introduction: Osteoarthritis (OA) is a common joint disorder, with the knee being one of the most frequently involved sites. Knee OA causes pain and stiffness and can lead to considerable disability and consequently to impaired quality of life. Aim of the work: Clinical evaluation of participant with painful knee OA to detect the possible causes of pain knee OA.Patients and Methods: Our study included 50 knee OA patients, attending to Sohag university hospitals rheumatology and rehabilitation outpatient clinic. They were divided according to pain into 2 groups. Group 1 with painful OA and group 2 with painless OA. Both groups were age and sex-matched.Results: Our study showed that the group 1 participants had more varus deformities, more and significant effusion and Baker cyst. Among painful OA patients, all factors showed non-significant relation to the degree of VAS.Conclusion: Our study found that knee effusion and Baker cyst were the main possible causes of pain in knee OA.

Anterior Knee Pain In A Runner

HISTORY: 40 yo F runner with bilateral, right, anterior, aching, intermittent, 3-10/10 knee pain. Wakes at night. Worse with going down stairs, running, fast walking. Better with rest and ibuprofen. ROS negative. PMHx: DVT, PE, depression, endometriosis, sleep apnea. PSHx: C-section, IVC filter. Meds: ibuprofen prn, citalopram, fluticasone nasal spray, Coumadin. FHx: DVT in father. SocHx: +tobacco, no alcohol or drug use; desk job; recreational runner. No recent immobilization/long travel. PHYSICAL EXAMINATION: BMI 38, vitals stable. Knee Exam: No malalignment, bruising, erythema, or obvious swelling; gait normal. Full AROM without pain; + patellar j sign; + patellar crepitus; 5/5 strength without pain; Neurovascularly intact. Negative patellar apprehension; equivocal patellar inhibition. positive patellar grind bilaterally. Full AROM. Negative bounce test, McMurray. Minimal tenderness of medial joint line. Palpable, firm 4cm mass in the right popliteal fossa that is mildly tender to palpation. No overlying skin changes. No ligamentous instability, calf pain, swelling, tenderness, warmth, erythema. Negative Homan’s sign. DIFFERENTIAL DIAGNOSIS: For mass: synovial/baker’s cyst, ganglionic cyst, meniscal cyst, DVT, aneurysm, muscular deformity, soft tissue mass TEST AND RESULTS: -2-view knee x-ray: ill-defined soft tissue sclerosis in the posteomedial right knee which could be a bone forming soft-tissue tumor, Moderate bilateral tricompartmental knee OA. -Knee MRIt: Round, lobular mass measuring 3 x 3 x 3.6 cm adjacent to the distal semimembranosus myotendinous junction. Central ossification and a thin rim of peripheral enhancement.A bone forming tumor, benign or malignant, is a possibility. -Bone tumor surgeon notified and patient seen. Felt unrelated to symptoms and likely secondary to prior trauma. CT knee and CXR. CXR normal. -CT without contrast: Soft tissue calcified lesion medial to the patient's small Baker's cyst partially surrounds the semitendinosus tendon. Tissue sampling is recommended to exclude a matrix forming neoplasm. Knee OA. -Sarcoma Tumor Board: benign; treat underlying knee pain. FINAL WORKING DIAGNOSIS: Benign soft tissue calcified lesion of the knee TREATMENT: symptomatic treatment, quit smoking, weight loss OUTCOME: asymptomatic at 2-months

Prevalence and associations of incidental nonvenous duplex findings discovered during lower extremity venous imaging

ObjectiveVenous duplex imaging defines venous pathology (VP). Unexpected clinically relevant findings are also found but rarely mentioned in the literature. This study aims to define the prevalence of ancillary findings (nonvenous duplex) by study type and venous outcome and subgroup associations with primary study indication and risk factors. MethodsOur vascular laboratory database was queried for lower extremity venous duplex studies with comments regarding ancillary findings and associated patient demographics, primary study indication, associated conditions, and venous study outcome. ResultsThere were 52,215 venous studies performed, 48,425 to evaluate for venous occlusion (acute/chronic) and 3790 for venous reflux. Of these studies, 15,810 found VP and 36,405 found no venous disease. There were 875 studies with venous disease that had ancillary duplex findings (5.5%) noted as 559 (3.5%) with prominent lymph node(s) (LN), 179 (1.1%) Baker's cyst (BC), 44 (0.3%) hematoma/mass (HM), 31 (0.2%) arterial aneurysm, and 16 (0.1%) arterial occlusion. There were 3130 studies free of VP with ancillary findings (8.6%) noted as 2258 (6.2%) prominent LN(s), 626 (1.7%) BC, 156 (0.4%) HM, 37 (0.1%) arterial aneurysm, and 22 (0.06%) arterial occlusion. The overall prevalence of ancillary findings was 8.62%. Analysis demonstrated statistically more ancillary findings in venous occlusion (odds ratio [OR], 1.25) studies, which was the largest group at 13 to 1. Studies free of venous disease had more ancillary findings (P < .001) with an OR of 1.88 and similar results were noted for LN(s), BC, and hematoma. Studies with VP favored a finding of aneurysm (OR, 0.52). Subgroup analyses demonstrated that those with prominent LN(s) were statistically older and male and BC statistically older in those with coexistent venous disease. BC subgroup analysis showed that studies free of venous disease were 2.5 times more likely to report pain as the primary study indication (P < .0001). In general, within ancillary subgroups, leg symptoms were statistically more prominent on the side with ancillary pathology and free of venous disease. ConclusionsAncillary findings are not uncommon and are more common in studies found free of VP. The most common are LNs, BC and HM and, within subgroups, significant leg symptoms favors the presence of ancillary findings without coexisting venous disease. Ancillary findings should be an integral part of a quality report.

5-year experience of minimally invasive treatment of Baker cysts in children in conditions of outpatient surgerycenter

5-year experience of minimally invasive treatment of Baker cysts in children in conditions of outpatient surgerycenter

Осложнение лазер-индуцированной термотерапии кисты Бейкера

Interventional laser-induced thermal therapy (LITT) is an emerging technique to treat popliteal synovial cysts. The goal of LITT is coagulation and subsequent obliteration of inosculation and cystic cavity under local tumescent anesthesia. Ultrasound is an imaging method used for LITT. Analyzing the results of the use of laser obliteration of Baker's cyst, the authors concluded that obliteration of solely the cystic popliteal cavity can provide persistent recovery. As expected, in any invasive procedure, there are some procedure-related adverse events or complications.

Clinical significance of bone marrow edema in the late stages of osteoarthritis

The use of magnetic resonance imaging (MRI) for osteoarthritis made it possible to simultaneously detail the state of cartilage, subchondral bone, menisci, ligaments, and synovial membrane. In some studies, a correlation was found between bone marrow edema (BME) and the intensity of the pain syndrome, the progression of OA and the risk of total knee replacement. In other studies, these data were not confirmed. It has been suggested that BME in OA, leading to debilitating pain, is not associated with trauma and is determined by an increase in extracellular fluid. Analysis of MRI images of 80 patients with 1-3 stages of knee osteoarthritis revealed a statistically significant relationship between the presence of bone marrow edema and the thickness of the cartilage of the femur and tibia, rupture and degradation of the medial menisci, the presence of Baker cysts and thickening of the synovial membrane. No reliable relationship was found with the presence and severity of synovitis. A review of data on the effect of various methods of conservative therapy on bone marrow edema in osteoarthritis is presented. The effect of anti-osteoporotic drugs, prostacyclin, Pentosan polysulfate sodium chondroitin sulfate is considered. Thus, OKM is of interest both in terms of the pathogenesis of OA and as an indicator of the effectiveness of the treatment of OA. Our data demonstrate a high incidence of OKM in the late stages of OA. The effect of pharmacological therapies on OKM requires further study.