Compartment syndrome secondary to Baker's cyst rupture: A case report and up-to-date review

Abstract

Baker's cyst is a distention or enlargement of the gastrocnemius-semimembranosus bursa toward the popliteal fossa which is usually associated with intra-articular pathologies. Rupture or dissection of the Baker's cyst results in extravasation of the cyst content into the calf within intermuscular space under the fascia. This clinical entity, also called pseudothrombophlebitis, is a self-limited condition that usually resolves with supportive treatment. However, in patients using anticoagulants, excessive hemorrhage may cause compartment syndrome in case of cyst rupture. Early diagnosis of compartment syndrome is the most important step in preventing permanent disability. Therefore, compartment syndrome should be kept in mind and ruled out in a patient with pseudothrombophlebitis syndrome under anticoagulation therapy.

Sudden calf swelling and pseudo-thrombophlebitis in rheumatoid arthritis: an uncommon emergency spot diagnosis

“…Popliteal cyst (or Baker's cyst) is a swelling resulting from distension of gastrocnemius-semimembranosus bursa that communicates with the knee joint (1). Mostly these are present as asymptomatic lesion with mild pain or clinically notable lumps.…”

“…Ruptured cyst may occasionally lead to resultant calf swelling making it one of the differential diagnosis of an acute or chronic calf swelling and should be investigated accordingly (3). Acute pain and swollen as well as tender calf may mimic deep vein thrombosis (DVT) or compartment syndrome and results from cyst rupture with its contents seeping into inter-muscular spaces (1,4). MRI is excellent in demarcation of fluid within musculofascial spaces and also helps to rule out mimicking disorders like DVT, rupture of medial gastrocnemius head or plantaris muscle, intramuscular hematoma, vascular disorders or neoplastic growths among others (1,3,4).…”

“…Acute pain and swollen as well as tender calf may mimic deep vein thrombosis (DVT) or compartment syndrome and results from cyst rupture with its contents seeping into inter-muscular spaces (1,4). MRI is excellent in demarcation of fluid within musculofascial spaces and also helps to rule out mimicking disorders like DVT, rupture of medial gastrocnemius head or plantaris muscle, intramuscular hematoma, vascular disorders or neoplastic growths among others (1,3,4). The clinical presentation of a sudden pain at back of the knee with or without erythema, and ecchymoses at calf and ankle and positive Homan's sign is also described as 'pseudothrombophlebitis' (3)(4)(5).…”

Die Bakerzyste – das stumpfe Damoklesschwert bei der Radiosynoviorthese (RSO)?

“…In vielen Fällen sind Bakerzysten asymptomatisch und werden als Zufallsbefunde diagnostiziert. Bei entsprechendem Volumen sind jedoch vielfältige Beschwerden wie eine mechanische, schmerzhafte Einschränkung der Flexion im Kniegelenk, Infektionen, neurovaskuläre Kompressionssyndrome oder gar ein mögliches Kompartmentsyndrom beschrieben [7]. Insbesondere das seltene Ereignis einer spontanen Ruptur oder Dissektion mit konsekutiver Freisetzung der Zystenflüssigkeit in die umgebenden Unterschenkellogen, in manchen Fällen auch mit einer Einblutung in die Muskulatur stellt jedoch ein für den Patienten akutes und sehr schmerzhaftes Ereignis dar.…”