Nonoperative management of lower extremity claudication caused by a Baker's cyst: case report and review of the literature.
A Baker's or popliteal cyst is a synovial cyst in the popliteal fossa arising from the knee joint. The majority of patients develop a popliteal mass that is asymptomatic, but in a small percentage of patients, complications and symptoms occur; these may not only encompass the popliteal veins and arteries but may also include cyst leakage, infection, hemorrhage, and compartment syndrome. Severe lower limb ischemia caused by a Baker's cyst is extremely rare, having been reported only six times since 1960; all patients were treated with surgical intervention. We report the case of a 29-year-old male presenting with right calf claudication caused by a Baker's cyst. The patient was managed nonoperatively with nonsteroidal anti-inflammatory agents, proper exercises, and close observation. His claudication improved progressively and had completely disappeared at 12 months of follow-up. A repeat duplex arterial study showed that increased blood flow to the right foot and the right ankle/brachial index improved to 0.97 from 0.67. Repeat ultrasonography demonstrated that the size of the cyst decreased from 4.5 x 1.5 cm to 2.8 x 0.9 cm. The patient had been followed for 20 months and remained asymptomatic in the last 8 months. We will continue to follow the patient to evaluate the long-term outcome. In summary, our own data and literature review suggest that the limb ischemia caused by Baker's cyst may be a transient condition and can be managed nonoperatively in selected patients.
Zhang
Wayne W
WW
Division of Vascular Surgery, Department of Surgery, Kaleida Health-Millard Fillmore Gates Hospital and University at Buffalo, The State University of New York, Buffalo, New York, USA.
Lukan
James K
JK
Dryjski
Maciej L
ML
D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D003251:Constriction, Pathologic; D006801:Humans; D007383:Intermittent Claudication / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D007719:Knee Joint / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D011151:Popliteal Cyst / Q000150:complications* / Q000175:diagnosis; D016896:Treatment Outcome
D000894:Anti-Inflammatory Agents, Non-Steroidal