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Arthroscopy Techniques Aug 2021Tuberculosis of the musculoskeletal system is uncommon and constitutes 1% to 5% of all forms of tuberculosis. In total, 30% of skeletal tuberculosis involves the joints,...
Tuberculosis of the musculoskeletal system is uncommon and constitutes 1% to 5% of all forms of tuberculosis. In total, 30% of skeletal tuberculosis involves the joints, the knee being the third most commonly affected after the spine and the hip. Knee tuberculosis commonly presents as synovitis or arthritis, and infected Baker's cyst is a rather rare presentation. It is believed to result from the propagation of tuberculosis of the knee joint into the cyst, as approximately one half of the Baker's cyst communicates with the knee joint and it appears as swelling in the medial aspect of the popliteal fossa. For tuberculous popliteal bursitis at the lateral aspect of the popliteal fossa, it may be an extra-articular extension of tuberculosis of the knee joint via the popliteal hiatus. Chemotherapy remains the cornerstone of treatment; surgery is indicated in recalcitrant cases. In this Technical Note, the technical details of endoscopic resection of recalcitrant tuberculous bursitis at the lateral aspect of the popliteal fossa are described. This minimally invasive technique has the advantage of better cosmetic results and fewer wound complications and reduces the extent of surgical dissection as compared with open surgery.
PubMed: 34401235
DOI: 10.1016/j.eats.2021.04.016 -
Malaysian Orthopaedic Journal Jul 2022Popliteal swelling is a common complaint seen in the practice of orthopaedics. Although imaging is useful to aid in the diagnosis of popliteal swelling pre-operatively,...
Popliteal swelling is a common complaint seen in the practice of orthopaedics. Although imaging is useful to aid in the diagnosis of popliteal swelling pre-operatively, definitive diagnosis is often obtained post-operatively through histopathological report of the swelling. Baker's cyst arises medially and hence usually spares the posterolaterally located neurovascular bundle until it becomes larger in size. A thrombosed aneurysm can mimic that of Baker's cyst on computed tomography (CT) imaging in view of its location and the absence of contrast within the lesion. Diagnosis of a popliteal swelling with neural or vascular compression is not as straightforward and surgeons should be well aware that intra-operative findings may differ from diagnosis made pre-operatively. Meticulous exploration is pertinent in identifying the origin of the swelling and structures related to it. MRI imaging of the swelling should be done pre-operatively whenever possible.
PubMed: 35992974
DOI: 10.5704/MOJ.2207.015 -
Journal of Thrombosis and Thrombolysis Oct 2022Popliteal cysts (PC) result from distension of the gastrocnemio-semimembranosous bursa. Published reports indicate coincident PC and deep vein thrombosis (DVT). Whether...
BACKGROUND
Popliteal cysts (PC) result from distension of the gastrocnemio-semimembranosous bursa. Published reports indicate coincident PC and deep vein thrombosis (DVT). Whether the presence of PC increase the risk of deep vein thrombosis (DVT) remains unclear.
METHODS
Lower extremity venous Duplex ultrasound (DUS) reports were evaluated across the Mayo Clinic Enterprise (Rochester, Minnesota, Jacksonville, Florida, Scottsdale, Arizona, and the Mayo Clinic Health System) in patients ≥ 18 years of age. Natural language processing (NLP) algorithms were created and validated to identify acute lower extremity DVT and PC from these reports. To determine whether there is a link between PC and lower extremity DVT, the frequency of PC among cases (ultrasounds with acute DVT) were compared to controls (ultrasounds without acute DVT).
RESULTS
A total of 357,703 lower extremities venous DUS were performed in 237,052 patients (mean age 63.3 ± 16.6, 54.4% were female) between 1992 and 2021. Acute DVT was identified in 32,572 (9.1%) DUS, and PC in 32,448 (9.1%). PC were seen in a lower frequency (8.0%) of ultrasounds with acute DVT than those without (9.2%) acute DVT (OR: 0.85, 95% CI: 0.82 to 0.89, p < 0.001). In a multivariate logistic regression model after adjusting for age, sex, and race, PCs were not positively associated with acute DVT (adjusted OR: 0.84, 95% CI: 0.81 to 0.88).
CONCLUSIONS
PC are an incidental finding or an alternative diagnosis on lower extremity venous DUS, a finding that increases significantly with age. PC were not a risk factor in the development of lower extremity DVT.
Topics: Acute Disease; Female; Humans; Lower Extremity; Male; Popliteal Cyst; Popliteal Vein; Retrospective Studies; Risk Factors; Ultrasonography, Doppler, Duplex; Venous Thrombosis
PubMed: 35932383
DOI: 10.1007/s11239-022-02685-7 -
Bulletin of the Hospital For Joint... Sep 2019The purpose of the study was to investigate clinical outcomes following a mini-open posterior technique.
PURPOSE
The purpose of the study was to investigate clinical outcomes following a mini-open posterior technique.
METHODS
Patients who received mini-open popliteal cyst excisions between April 1999 and April 2010 were identified. Charts were retrospectively reviewed for postoperative complications, cyst recurrence, previous aspiration, re-operation, intraoperative findings, cyst size, comorbidities, and co-surgeries. Visual Analogue Pain Scale and Rauschning's symptomatic knee criteria were collected prospectively to assess functional outcomes.
RESULTS
Twenty-two legs in 21 patients were included in the study [males: 12 (57%); females: 9 (43%); age: 48.23 ± 11.74 years; BMI: 26.7 ± 4.54 kg/m2; follow-up: 4.55 ± 3.01 years]. Average cyst size was 4.16 ± 1.64 cm and were all located in the posteromedial aspect of the leg. All 22 cases had associated intra-articular pathology based on MRI, physical examination, and arthroscopy. Complications after cyst excision included: paresthesia in the distribution of the saphenous nerve (3/22, 14%), keloid formation (1/22, 4%), joint effusion requiring aspiration (1/22, 4%), and one recurrence requiring cystectomy 10 years later (4%). All incidences of paresthesia resolved. Mean visual analog pain score decreased by 6 points (p < 0.001) and Rauschning and Lindgren score decreased by two categories, from a 2.6 (category 2-3) preoperatively to 0.6 (category 0-1) postoperatively (p < 0.001).
CONCLUSION
Mini-open popliteal cyst excision is a safe and effective technique for refractory popliteal cysts in patients who desire a decrease in pain, an increase range of motion, and improved function in knee flexion and extension. Further studies are needed to evaluate the clinical outcomes of patients over a longer duration as our one patient with a 10-year follow-up required a repeat procedure.
Topics: Arthroscopy; Dissection; Female; Humans; Knee Joint; Magnetic Resonance Imaging; Male; Middle Aged; Minimally Invasive Surgical Procedures; Outcome and Process Assessment, Health Care; Popliteal Cyst; Postoperative Complications; Range of Motion, Articular; Recovery of Function; Reoperation; United States
PubMed: 31487479
DOI: No ID Found -
Journal of Vascular Surgery. Venous and... Jan 2021Venous duplex imaging defines venous pathology (VP). Unexpected clinically relevant findings are also found but rarely mentioned in the literature. This study aims to...
OBJECTIVE
Venous duplex imaging defines venous pathology (VP). Unexpected clinically relevant findings are also found but rarely mentioned in the literature. This study aims to define the prevalence of ancillary findings (nonvenous duplex) by study type and venous outcome and subgroup associations with primary study indication and risk factors.
METHODS
Our vascular laboratory database was queried for lower extremity venous duplex studies with comments regarding ancillary findings and associated patient demographics, primary study indication, associated conditions, and venous study outcome.
RESULTS
There were 52,215 venous studies performed, 48,425 to evaluate for venous occlusion (acute/chronic) and 3790 for venous reflux. Of these studies, 15,810 found VP and 36,405 found no venous disease. There were 875 studies with venous disease that had ancillary duplex findings (5.5%) noted as 559 (3.5%) with prominent lymph node(s) (LN), 179 (1.1%) Baker's cyst (BC), 44 (0.3%) hematoma/mass (HM), 31 (0.2%) arterial aneurysm, and 16 (0.1%) arterial occlusion. There were 3130 studies free of VP with ancillary findings (8.6%) noted as 2258 (6.2%) prominent LN(s), 626 (1.7%) BC, 156 (0.4%) HM, 37 (0.1%) arterial aneurysm, and 22 (0.06%) arterial occlusion. The overall prevalence of ancillary findings was 8.62%. Analysis demonstrated statistically more ancillary findings in venous occlusion (odds ratio [OR], 1.25) studies, which was the largest group at 13 to 1. Studies free of venous disease had more ancillary findings (P < .001) with an OR of 1.88 and similar results were noted for LN(s), BC, and hematoma. Studies with VP favored a finding of aneurysm (OR, 0.52). Subgroup analyses demonstrated that those with prominent LN(s) were statistically older and male and BC statistically older in those with coexistent venous disease. BC subgroup analysis showed that studies free of venous disease were 2.5 times more likely to report pain as the primary study indication (P < .0001). In general, within ancillary subgroups, leg symptoms were statistically more prominent on the side with ancillary pathology and free of venous disease.
CONCLUSIONS
Ancillary findings are not uncommon and are more common in studies found free of VP. The most common are LNs, BC and HM and, within subgroups, significant leg symptoms favors the presence of ancillary findings without coexisting venous disease. Ancillary findings should be an integral part of a quality report.
Topics: Adult; Aged; Aged, 80 and over; Databases, Factual; Female; Hematoma; Humans; Incidental Findings; Lower Extremity; Lymph Nodes; Male; Middle Aged; Popliteal Cyst; Predictive Value of Tests; Prevalence; Retrospective Studies; Ultrasonography, Doppler, Duplex; Vascular Diseases; Veins
PubMed: 32599309
DOI: 10.1016/j.jvsv.2020.06.013 -
Journal of Back and Musculoskeletal... 2020Pain is a significant cause of disability in knee osteoarthritis. Conventional radiography is widely used in the assessment of knee osteoarthritis, however radiographic...
BACKGROUND
Pain is a significant cause of disability in knee osteoarthritis. Conventional radiography is widely used in the assessment of knee osteoarthritis, however radiographic findings do not correlate well with pain. Ultrasonography can be used to evaluate the soft tissue structures of the knee that can be related to pain.
OBJECTIVE
To evaluate pain-related soft tissue structures of the knee with ultrasonography.
METHODS
This cross-sectional study included a total of 198 knees from 99 patients with knee osteoarthritis. Knee pain and functional status were evaluated by performing visual analogue scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). On the ultrasound, cartilaginous thickness, knee effusion and presence of Baker's cyst were assessed and the correlation to pain was investigated.
RESULTS
Baker's cyst was significantly more frequent in symptomatic knees (13.9%) compared to asymptomatic knees (2.5%). Patients with Baker's cyst had a significantly more limited degree of knee flexion, significantly higher resting VAS pain scores and worse WOMAC scores compared to patients without Baker's cyst. In log-linear analysis, presence of Baker's cyst increased the risk of pain by 2.94 times.
CONCLUSION
Ultrasound as a modality that is easily accessible, inexpensive and without radiation exposure is helpful to demonstrate factors related to pain in knee osteoarthritis by allowing assessment of soft tissue structures.
Topics: Adult; Aged; Cross-Sectional Studies; Female; Humans; Knee; Knee Joint; Male; Middle Aged; Osteoarthritis, Knee; Pain; Pain Measurement; Popliteal Cyst; Ultrasonography
PubMed: 31771037
DOI: 10.3233/BMR-191504 -
EJVES Vascular Forum 2022Cystic adventitial disease (CAD) is characterised by the accumulation of gelatinous fluid within the adventitial layer of a blood vessel. Over 90% of CAD occurs in the...
INTRODUCTION
Cystic adventitial disease (CAD) is characterised by the accumulation of gelatinous fluid within the adventitial layer of a blood vessel. Over 90% of CAD occurs in the arterial system. Venous CAD most commonly involves the iliofemoral rather than the popliteal segments.
REPORT
This is the report of a 49 year old female patient with a previous right leg deep vein thrombosis (DVT). She presented to a vascular outpatient appointment with recurrent right lower extremity swelling. Venous duplex ultrasound showed an ectatic and incompetent right popliteal vein. Computed tomography (CT) venography showed focal ectasia of the right popliteal vein resulting from an eccentric low density cyst with a diameter of 15 mm. Under general anaesthesia, the patient was placed in the prone position. A lazy S incision was performed in the right popliteal fossa. The popliteal vein had an eccentrically thickened lateral bulge. After heparinisation, a longitudinal venotomy, endophlebectomy, and cyst removal were performed sequentially. Popliteal patch venoplasty was performed subsequently using the ipsilateral small saphenous vein. After six months, the patient remains on rivaroxaban. A follow up venous duplex ultrasound showed vein reflux through a standard calibre popliteal vein without evidence of cyst recurrence.
CONCLUSION
Venous CAD is a rare disease and should be considered if previous DVT or symptoms mimicking DVT occur. Cyst resection and reconstruction with vein patch, venous or synthetic graft is the most commonly used strategy and has lower rates of cyst recurrence and need for re-operation.
PubMed: 35300406
DOI: 10.1016/j.ejvsvf.2022.02.002 -
Vascular Specialist International Jun 2020Adventitial cystic disease (ACD) is a very rare condition characterized by the accumulation of a cyst filled with gelatinous substance in the adventitia of a vessel... (Review)
Review
Adventitial cystic disease (ACD) is a very rare condition characterized by the accumulation of a cyst filled with gelatinous substance in the adventitia of a vessel adjacent to the joint area. The cyst usually compresses the vessel lumen, causing claudication or leg swelling. The disease usually affects the popliteal artery. However, several cases of venous ACDs particularly in the common femoral or external iliac vein have been reported. The definition, diagnosis, and optimal treatment of ACD remain controversial because of its rarity and the inconsistent use of terminology. The heterogeneity of the reported cases is more prominent in venous ACD. Herein, the accurate terminology of cysts correlated to the joint (synovial cyst, ganglion cyst, and adventitial cyst) and the pathogenesis, anatomy, and optimal therapy of venous ACD are discussed in detail to establish reporting standards for future studies.
PubMed: 32611837
DOI: 10.5758/vsi.200029 -
Journal of Ayub Medical College,... 2022Echinococcosis is a disease that has been affecting human beings since decades and is primarily a zoonotic disease. The larvae of genus Echinococcus causes this disease....
Echinococcosis is a disease that has been affecting human beings since decades and is primarily a zoonotic disease. The larvae of genus Echinococcus causes this disease. The most common sites for these cysts are the lungs and liver. Cardiac hydatidosis is a rare phenomenon and the incidence of such cases is about 1.3%. The case presented is of a 15- year-old boy who would have shortness of breath on exertion and acute right leg pain. To diagnose cardiac variant of the cystic disease, computed topography (CT) and echocardiography were done. Doppler studies confirmed acute limb ischemia. The treatment modality was an open-heart surgery and bilateral embolectomy of the popliteal artery. The patient was discharged to home with albendazole chemotherapy. The study gives an insight into an unusual presentation and successful treatment of cardiac hydatid cyst as well as the associated complications that can be encountered.
Topics: Adolescent; Albendazole; Animals; Echinococcosis; Echinococcus; Echocardiography; Heart Ventricles; Humans; Male
PubMed: 35576309
DOI: 10.55519/JAMC-02-9222 -
Cureus Jan 2023The prevalence of peripheral artery disease (PAD) has been increasing in parallel with the increasing prevalence of the atherosclerotic disease. Therefore, we have to be...
The prevalence of peripheral artery disease (PAD) has been increasing in parallel with the increasing prevalence of the atherosclerotic disease. Therefore, we have to be familiar with the diagnostic approach used for ischemic symptoms in the lower limbs. Adventitial cystic disease (ACD) is rare but not negligible as one of the differential diagnoses of intermittent claudication (IC). Although duplex ultrasound and magnetic resonance imaging (MRI) are helpful tools for the diagnosis of ACD, further imaging modality is needed to avoid misdiagnosis. A 64-year-old man with a mitral valve prosthesis presented to our hospital with a one-month history of IC in the right calf after walking for approximately 50 meters. On physical examination, the pulse in the right popliteal artery was not palpable, nor were the dorsal pedis artery and posterior tibial artery, although there were no other symptoms of ischemia. His right ankle-brachial index (ABI) was 1.12 at rest but decreased to 0.50 after exercise. Three-dimensional computed tomography (CT) angiography revealed a severe stenotic lesion approximately 70 mm long in the right popliteal artery. Therefore, we diagnosed PAD in the right lower limb and planned endovascular therapy. The stenotic lesion was markedly reduced on catheter angiography when compared with CT angiography. However, intravascular ultrasound (IVUS) detected little atherosclerosis and cystic lesions within the wall in the right popliteal artery that did not involve the arterial lumen. Especially, IVUS clearly demonstrated that the crescent-shaped cyst compressed the arterial lumen eccentrically and other cysts surrounded the lumen circumferentially like petals. Because IVUS revealed these cysts to be extravascular structures, the patient was subsequently thought to have ACD of the right popliteal artery. Fortunately, his cysts reduced in size spontaneously and his symptoms disappeared. We have monitored the patient's symptoms, ABI, and findings on duplex ultrasound for seven years, during which there has been no recurrence. In this case, we diagnosed ACD in the popliteal artery by IVUS rather than duplex ultrasound and MRI.
PubMed: 36874647
DOI: 10.7759/cureus.34362