Ruptured or Dissected Popliteal Cyst in Patients with Calf Symptoms

Seung-Ki Kwak; Zee-A Han; Mi-Sook Sung; Jun-Ki Min

doi:10.4078/jkra.2008.15.3.212

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Kwak, Han, Sung, and Min: Ruptured or Dissected Popliteal Cyst in Patients with Calf Symptoms

Original Article

J Korean Rheum Assoc 2008;15(3):212-212.

Published online: 20 September 2008

DOI: https://doi.org/10.4078/jkra.2008.15.3.212

Ruptured or Dissected Popliteal Cyst in Patients with Calf Symptoms

Seung-Ki Kwak², Zee-A Han³, Mi-Sook Sung⁴, Jun-Ki Min¹

¹Division of Rheumatology, Holy Family Hospital, Bucheon, St. Mary's Hospital, Seoul, Korea

²Department of Internal Medicine, Holy Family Hospital, Bucheon, St. Mary's Hospital, Seoul, Korea

³Department of Rehabilitation Medicine, Seoul, Korea

⁴Department of Radiology, Holy Family Hospital, Bucheon, College of Medicine, The Catholic University of Korea, Seoul, Korea

Received 12 July 2008 Accepted 26 July 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Keywords: Calf symptom, Complicated popliteal cyst, Magnetic resonance imaging, Ultrasonography

References

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Fig. 1.

A 46-year-old woman with rheumatoid arthritis and ruptured and dissected baker cyst. Ultrasonogram shows typical location of the baker cyst in the space between the medial head of the gastrocnemius and semembranosus (A). Anechoic dissected baker cyst with internal synovial proliferation demonstrates in the space between the medial head gastrocneiums and superficial fascia (B). Coronal fat suppressed T2-weighted MR image show high signal intensity of baker cyst with rupture and dissection into the space between the medial head gastrocnemius and superficial fascia. There is an extension into the subcutaneous tissue layer (C, arrow).

Fig. 2.

A-72-year old woman with rheumatoid arthritis and ruptured and dissected baker cyst. Axial T1-weighted MR image (A), T2-weighted image (B), and coronal sagittal fat-suppressed image (C) show ruptured and dissected baker cyst, appearing with heterogeneous high signal intensity due to internal synovial proliferation and hemorrhage within the gastrocnemius muscle and space between the superficial fascia and the both head of the gastrocnemius muscle (arrow).

Table 1.

Causes of calf symptoms

	Doppler US	US	MRI
Subcutaneous lesions (28)
Cellulitis	3	3	8
Fat necrosis		3
Panniculitis		2
Non-specific lesion		9
Musculotendinous lesions (23)	)
Achilles tendon rupture		9	2
Tennis leg (1∗)		3	8
Muscle herniation		2	1
Vascular lesions (59)
DVT	46	1	1
SVT	5^†	3	1
Arterial thrombosis (1∗)	1		1
Venous insufficiency	1
Tumor (13) (1∗)		3	10
Popliteal cyst (15) (3∗)	3	3	9 (1^‡)
Miscellaneous lesions (10)	5	1	4
Idiopathic (52)	43	7	2
Total	107	49	47
∗the number of patients evaluated with combined diagnostic modalities.^†Five patients had both SVT and DVT.^‡One patient had both hemangioma and popliteal
cyst
US: ultrasonography, MRI: magnetic resonance imaging,

DVT: deep vein thrombosis, SVT: superficial vein thrombosis

Table 2.

Characteristics of the complicated popliteal cysts

Patient number	Age/sex	D or R	Presenting symptoms	Extension of popliteal cyst Meniscus tear	Cartilage abnormality	y Joint effusion Radiologic study Underlying disease
1	67/F	DR	mass	G-F NA	NA	Yes US
2	69/F	DR	pain	G-F, SC No	Yes	Yes MRI
3	46/F	DR	pain	G-F, IM, SC No	No	Yes Doppler US, MRI RA
4	56/F	DR	pain	G-F MM, LM	Yes	Yes MRI
5	72/F	DR	pain	G-F, IM MM	Yes	Yes Doppler US, MRI RA
6	57/M	R	pain	G-F MM	No	Yes US, MRI
7	20/M	DR	mass	G-F No	No	Yes MRI
8	70/M	DR	mass	G-F MM	Yes	Yes MRI
9	65/F	DR	pain	G-F NA	NA	NA Doppler US RA
10	66/M	DR	mass	G-F, SC No	No	Yes MRI
11	56/F	DR	mass	G-F NA	NA	Yes US
12	73/F	R	mass	G-F MM	No	Yes MRI
D: dissection, R: rupture, G: gastrocnemius, G-F: space between the medial head of the gastrocnemius and superficial
fascia; NA: not available, SC: subcutaneous, IM: intramuscular, RA: rheumatoid arthritis, MM: medial meniscus, LM:

lateral meniscus

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