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Clinical Case Unilateral limb swelling Nicos Labropoulos Professor of Surgery and Radiology Director, Vascular Laboratory Division of Vascular Surgery Stony Brook University Medical Center Stony Brook, NY nlabrop@yahoo.com. Deep Venous Summit. Disclosures. Cook Speaker, received honoraria
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Clinical Case Unilateral limb swelling Nicos LabropoulosProfessor of Surgery and RadiologyDirector, Vascular LaboratoryDivision of Vascular SurgeryStony Brook University Medical CenterStony Brook, NYnlabrop@yahoo.com Deep Venous Summit
Disclosures Cook Speaker, received honoraria Philips IGT Speaker, received honoraria Dr. Labropoulos has received compensation from Philips IGT for his time to prepare and deliver this presentation The content of this presentation was independently prepared. The opinions expressed herein are those of the presenter and are not necessarily indicative of the views of any other party
Male 46 years old presented with pain and swelling Pain started a week ago at the posteromedial knee In a period of a 3 days he developed significant swelling from the knee to the ankle. The swelling was getting progressively worst until he came at the ER 7 days later. No history of thrombosis, trauma or surgery No medications He was sent to have a left lower extremity venous ultrasound.
Pain and swelling Became progressively worse
What would do next? • CT venogram of abdomen and pelvis • Lower extremity venous ultrasound • D-dimer • Venography
What would do next? • CT venogram of abdomen and pelvis • Lower extremity venous ultrasound • D-dimer • Venography
Fluid at the ankle level Lower Upper
Fluid in the knee joint Compression of the fluid
What is the pathology seen by ultrasound? • Hematoma • Adventitial cyst • Tumor • Baker cyst
What is the pathology seen by ultrasound? • Hematoma • Adventitial cyst • Tumor • Baker cyst
Adams R. Arthritis, chronic rheumatic, of the knee joint. Dublin J Med Sci1840;17:520–23 Baker WM. On the formation of synovial cysts in the leg in connection with disease of the knee joint. St Bartholomew’s Hospital Reports 1877;13:245–261 Labropoulos N, et al. New insights into the development of popliteal cysts. Br J Surg 2004;91:1313–18 Popliteal cysts form in the posteromedial popliteal fossa because the synovial capsule does not provide anatomical support in this region.
Sanchez JE, Conkling N, Labropoulos N. Compression syndromes of the popliteal neurovascular bundle due to Baker cyst. J VascSurg 2011;54:1821-9 Popliteal vein compression most common with or without thrombosis Tibial nerve compression Popliteal artery compression Rare Compartment syndrome Rare
M 57 years old Right lower limb swelling and pain that became progressively worst in the last 2 days No varicose veins No DVT Hemorrhagic popliteal cyst Significant compression of the popliteal vein and tibial nerve Sanchez JE, Conkling N, Labropoulos N. Compression syndromes of the popliteal neurovascular bundle due to Baker cyst. J VascSurg 2011;54:1821-9
Sanchez JE, Conkling N, Labropoulos N. Compression syndromes of the popliteal neurovascular bundle due to Baker cyst. J VascSurg 2011;54:1821-9 73 cases in 30 publications Nerve compression 17 Tibial 13 Common peroneal 2 Sciatic 1 Popliteal vein compression 47 Popliteal artery compression 5 Compartment syndrome 4
Sanchez JE, Conkling N, Labropoulos N. Compression syndromes of the popliteal neurovascular bundle due to Baker cyst. J VascSurg 2011;54:1821-9 Baker cyst is an important pathology for the differential diagnosis of popliteal neurovascular compression phenomena. It has a wide spectrum of presentation, therefore requiring accurate diagnosis for proper patient management. Because Baker cyst is by definition a chronic disorder, long-term follow-up is necessary to monitor patient recovery and prevent recurrence.