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Clinical Case Unilateral limb swelling

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

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  1. 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

  2. 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

  3. 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.

  4. Limb asymmetry

  5. Pain and swelling

  6. Pain and swelling Became progressively worse

  7. What would do next? • CT venogram of abdomen and pelvis • Lower extremity venous ultrasound • D-dimer • Venography

  8. What would do next? • CT venogram of abdomen and pelvis • Lower extremity venous ultrasound • D-dimer • Venography

  9. There was no deep vein thrombosis

  10. Mass in the popliteal fossa

  11. Fluid at the ankle level Lower Upper

  12. Fluid in the knee joint Compression of the fluid

  13. Comparison between the left and right knee

  14. Compression of the popliteal vein, the artery is normal

  15. Compression of the left popliteal vein

  16. What is the pathology seen by ultrasound? • Hematoma • Adventitial cyst • Tumor • Baker cyst

  17. What is the pathology seen by ultrasound? • Hematoma • Adventitial cyst • Tumor • Baker cyst

  18. 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.

  19. 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

  20. 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

  21. 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

  22. 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.

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