2018 Volume 29 Issue 3 Pages 399-403
Popliteal cyst, also called Baker’s cyst, is a popliteal fossa enlargement filled with synovial fluid. Baker’s cysts can be symptomatic and cause considerable pathologies such as thrombophlebitis, compartment syndrome and even nerve entrapment. Vascular surgeon has a chance to find a Baker’s cyst during the diagnosis of deep vein thrombosis (DVT) or varicose veins. Although most of the Baker’s cysts are treated by orthopedic surgeon, vascular surgeon may treat them in selected cases. The purpose of this study was to determine the incidence and characteristics of Baker’s cysts discovered during venous duplex examinations to rule out deep vein thrombosis (DVT) or varicose veins.
The patients who were diagnosed as Baker’s cyst at our department between 2009 and 2017 were reviewed retrospectively. All patients in the study underwent ultrasonographic examination. Six (1.9%) of 310 patients who were suspected of DVT and 13 (0.6%) of 2135 patients with varicose veins were found to have Baker’s cysts. The total of 19 patients consisted of 2 males and 17 females. The ages ranged from 55 to 81 (median 72) and affected sides were 13 left and 6 right. No thrombus was visualized by ultrasonography in the all 6 patients who were suspected of DVT. Four of them were diagnosed as ruptured Baker’s cysts and one patient was treated with aspiration of the residual fluid. Two patients had non-ruptured Baker’s cysts and they were treated with aspiration. Eight patients had the incompetence of the long saphenous vein and Baker’s cysts were detected on the same limbs. Five of them were undergone operation (EVLA, EVLA and aspiration, stripping and aspiration, sclerotherapy, only aspiration). Five patients had non-saphenous type varicose veins and two of them were treated with aspiration of the cysts. No complications occurred secondary to percutaneous treatment. Repeat ultrasonography demonstrated that the size of the cyst decreased.
The rupture of a Baker’s cyst results in a swollen, painful leg that is clinically indistinguishable from acute deep vein thrombosis. The therapeutic implications of pseudothrombophlebitis are of major significance with respect to the avoidance of anti-coagulation and ultrasound-guided aspiration of the cyst. Careful examination of the popliteal fossa should be performed during venous duplex examinations regardless of the indication for the study. There are few reports discussing the Baker’s cysts associated with varicose veins. We think that it is acceptable for the vascular surgeons to treat the cysts by aspiration at the same time of the treatment of varicose veins from the standpoint of patients’ benefits.
