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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 -
Frontiers in Cardiovascular Medicine 2022Intramuscular ganglion cyst (IMGC) is a very rare lesion with an unidentified pathogeny that originates within the muscle. We encountered a case of 49-year-old man who...
Intramuscular ganglion cyst (IMGC) is a very rare lesion with an unidentified pathogeny that originates within the muscle. We encountered a case of 49-year-old man who complained of intermittent claudication in the right lower limb for 2 months. An intramuscular ganglion cyst in the biceps femoris muscle was diagnosed and located by Computed tomography angiography (CTA) and magnetic resonance imaging (MRI), which compressed the popliteal artery and resulted in ischemia in the right lower limb. Six months after surgical resection, there was no recurrence of the cyst and the popliteal artery was patency. We describe this case with a review of the relevant literature.
PubMed: 36505376
DOI: 10.3389/fcvm.2022.1018694 -
Cureus Aug 2022Popliteal cysts represent one of the commonest knee pathologies in the adult population. The vast majority of cases may be treated conservatively as symptoms tend to...
Popliteal cysts represent one of the commonest knee pathologies in the adult population. The vast majority of cases may be treated conservatively as symptoms tend to resolve spontaneously. However, few patients may experience persistent pain and nerve-related symptoms not responding to conservative management. We present a case of a 46-year-old patient who suffered from tibial nerve palsy due to a popliteal cyst that was treated successfully with combined open and arthroscopic procedure. It is important to understand that popliteal cysts rarely may lead to tibial nerve entrapment and in selected cases operative management may be indicated.
PubMed: 36120222
DOI: 10.7759/cureus.27984 -
BMJ Case Reports Oct 2023
Topics: Humans; Popliteal Cyst; Diagnosis, Differential; Ultrasonography
PubMed: 37793850
DOI: 10.1136/bcr-2023-257869 -
Journal of Neurosurgery. Case Lessons Sep 2023Intraneural cysts involving the tibial nerve in the knee region (popliteal fossa) are rare. According to the articular (synovial) theory, which posits a joint origin for...
BACKGROUND
Intraneural cysts involving the tibial nerve in the knee region (popliteal fossa) are rare. According to the articular (synovial) theory, which posits a joint origin for this pathology, these cysts originate from either the superior tibiofibular joint (STFJ) or the tibiofemoral (knee) joint. As tibial intraneural cysts arising from the tibiofemoral joint remain poorly understood, the authors present 2 illustrative cases and a review of the world's literature on all tibial intraneural ganglion cysts in the knee region.
OBSERVATIONS
Fourteen cases of tibial intraneural ganglion cysts arising from the tibiofemoral joint were identified in the literature. Different articular branch patterns were demonstrated, which could be explained by the varied, rich articular branch innervation at the knee. Favorable outcomes were observed in cases in which the articular branch had been disconnected and the cyst drained and were comparable to the outcomes seen in tibial intraneural ganglion cysts with an STFJ origin.
LESSONS
Tibial intraneural cysts in the knee region can be subdivided by their joint of origin: the STFJ or the tibiofemoral joint. Those arising from the tibiofemoral joint originate from different areas of the joint and propagate in predictable patterns, with favorable outcomes following surgical intervention when the joint connection is identified and treated. The origin of tibial intraneural cysts from the tibiofemoral joint are more complex than those originating from the STFJ but seem to have similar propagation patterns and outcomes.
PubMed: 37728275
DOI: 10.3171/CASE23314 -
Journal of the College of Physicians... Dec 2022Compression of the common peroneal nerve by lateral meniscal cysts is rare. We report a 29-year male patient who complained of a gradually enlarging mass in the right...
Compression of the common peroneal nerve by lateral meniscal cysts is rare. We report a 29-year male patient who complained of a gradually enlarging mass in the right popliteal fossa. He was diagnosed with a lateral meniscal cyst and a common peroneal nerve injury. The patient underwent arthroscopic surgery, including lateral partial meniscectomy and cyst drainage. When followed up at 3 months, the dorsal extensor strength of the right foot recovered to grade 5, and sensation of the distal right lower limb returned to normal. No recurrence of the cyst was found at the last follow-up at 18 months. This is a rare case of common peroneal nerve paralysis caused by a lateral meniscal cyst. Key Words: Meniscal cyst, Common peroneal nerve, Nerve injury.
Topics: Humans; Male; Peroneal Neuropathies; Peroneal Nerve; Cysts; Menisci, Tibial; Arthroscopy
PubMed: 36597339
DOI: 10.29271/jcpsp.2022.Supp0.SS203 -
Journal of the Belgian Society of... Jul 2020This clinical case shows the importance of also examining the arteries when investigating suspected deep venous thrombosis.
This clinical case shows the importance of also examining the arteries when investigating suspected deep venous thrombosis.
PubMed: 32676549
DOI: 10.5334/jbsr.2109 -
European Radiology Mar 2020The purpose of this study was to investigate whether Baker cyst (BC) was related to the specific arrangement of the medial head of gastrocnemius tendon (MHGT) and the...
PURPOSE
The purpose of this study was to investigate whether Baker cyst (BC) was related to the specific arrangement of the medial head of gastrocnemius tendon (MHGT) and the semimembranosus tendon (SMT).
MATERIALS AND METHODS
Patients who underwent knee MRI with "Baker cyst" in PACS from August 2017 to February 2018 were included in this study. Patients who did not have BC in a knee MRI performed during the same period were included in the control group. A total 210 patients were selected for inclusion in this study. For the imaging analysis, the arrangement pattern between MHGT and SMT was classified into three types: type 1, concave; type 2, flat; and type 3, convex. When imaging analysis was performed, the amount of effusion, the presence of osteoarthritis, and major ligament and meniscal tears were also described. Univariate and multivariate logistic regression analyses were performed. Statistical significance was considered at p < 0.05.
RESULTS
The frequency of types 1, 2, and 3 was statistically significant depending on the presence or absence of BC (p < 0.001). The frequency of type 3 was the highest in the presence of BC, while that of type 1 was the highest in the absence of BC. BC was more common in type 2 (OR = 2.54; 95% CI = 1.27-5.07) and type 3 (OR = 4.09; 95% CI = 1.88-8.89).
CONCLUSION
BC is more likely to occur in patients with SMT having a convex shape for MHGT.
KEY POINTS
• Based on axial image of MRI only, one can predict which patients are morphologically more prone to develop a Baker cyst. • On axial images of MRI, Baker cyst is more likely to occur in patients with semimembranosus tendon having a convex shape for medial head of gastrocnemius tendon. • Baker cyst is not associated with the amount of effusion, OA, or internal derangement.
Topics: Adolescent; Adult; Aged; Female; Hamstring Tendons; Humans; Incidence; Knee Injuries; Knee Joint; Magnetic Resonance Imaging; Male; Middle Aged; Popliteal Cyst; Prevalence; Republic of Korea; Young Adult
PubMed: 31811432
DOI: 10.1007/s00330-019-06472-6 -
Vascular and Endovascular Surgery Feb 2023Venous cystic adventitial disease (VCAD) is a rare vascular anomaly located in the common femoral vein in most cases. We describe the case of a 59-year-old female...
Venous cystic adventitial disease (VCAD) is a rare vascular anomaly located in the common femoral vein in most cases. We describe the case of a 59-year-old female patient with right leg edema who was misdiagnosed with deep vein thrombosis of the lower extremity at another hospital. Magnetic resonance angiography revealed a round mass in the popliteal vein, with a narrow lumen. Considering the location of the lesion, absence of a history of deep venous thrombosis and trauma, and clinical manifestations, the diagnosis is likely a popliteal vein adventitial cyst. Segmental popliteal vein resection and reconstruction were performed using a cylindrical great saphenous vein graft. No joint connection was found during the operation, and the postoperative pathology confirmed VCAD.
Topics: Female; Humans; Middle Aged; Popliteal Vein; Cysts; Treatment Outcome; Vascular Diseases; Femoral Vein
PubMed: 36167456
DOI: 10.1177/15385744221130842 -
American Journal of Physical Medicine &... Jan 2020The aim of the study was to compare the clinical, radiographic, and ultrasound findings between simple and complicated Baker's cysts. (Comparative Study)
Comparative Study
PURPOSE
The aim of the study was to compare the clinical, radiographic, and ultrasound findings between simple and complicated Baker's cysts.
METHODS
Forty-seven knees with Baker's cysts in 45 patients with knee pain were identified from a chart review. Baker's cysts were classified as simple or complicated according to ultrasound findings. Clinical data, including duration of knee pain, visual analog scale score, Kellgren-Lawrence grade, ultrasound findings, including the size and sonomorphology of the BC, severity of osteophytosis, thickness of joint effusion, meniscal tear, and synovial proliferation of the two types of BC, were compared.
RESULTS
There were 22 knees with a simple cyst and 25 knees with a complicated cyst. The thickness of the suprapatellar effusion in complicated Baker's cysts (5.7 ± 3.0 mm) was significantly greater than that in simple Baker's cysts (3.8 ± 3.2 mm), and the presence of synovial proliferation in the suprapatellar recess was significantly higher in complicated Baker's cysts (22 knees, 88.0%) than in the simple Baker's cysts (12 knees, 54.5%). However, there were no significant differences in demographic, radiographic, and other ultrasound parameters between the two types of BC.
CONCLUSIONS
Synovial proliferation with larger effusion in the suprapatellar recess was more associated with complicated BC than simple BC.
Topics: Adult; Aged; Aged, 80 and over; Cell Proliferation; Cross-Sectional Studies; Female; Humans; Knee; Male; Middle Aged; Patella; Popliteal Cyst; Radiography; Retrospective Studies; Synovial Fluid; Ultrasonography
PubMed: 31335340
DOI: 10.1097/PHM.0000000000001263