(Fig 4-D.09) Ruptured Baker’s Cyst

https://youtu.be/Bb9ZrWMaYqk

https://youtu.be/YiEAI7pISIU

 

 

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📌 Ruptured Baker’s Cyst

 

A ruptured Baker’s cyst, also known as a popliteal cyst, is efficiently demonstrated on MRI as a high signal intensity edema dispersing into the adjacent soft tissues and fascial planes on fat-suppressed T2-weighted sequences.

✅ Complications

1️⃣ Dissection: The cyst typically dissects inferomedially but can also dissect proximally, anteriorly, intermuscularly, or intramuscularly.

• Presentation: A dissecting Baker’s cyst may present with tender fullness at the posteromedial aspect of the knee just below the joint. These lesions represent rare instances where a Baker’s cyst enters through the muscle fascia and is present both outside and within a muscle compartment.
• Normally, a Baker’s cyst enlarges in the direction of least resistance, most commonly along the medial gastrocnemius muscle belly distally. If a focal fascial defect occurs, or at a pre-existing weak region, the Baker’s cyst can enter the muscle compartment.

2️⃣ Rupture: Leaking of cyst fluid into the popliteal fossa, between fascial planes, and surrounding the hamstrings and medial gastrocnemius muscles. This is accompanied by edema of the soft tissue and irregularity of the cyst wall .

3️⃣ Compression: The enlarged cyst can compress the popliteal vessels and tibial nerve, leading to vascular and neurological symptoms.

4️⃣ Compartment Syndrome: The cyst can cause compartment syndrome, which can be either anterior or posterior.

 

✅ Clinical Presentation

• Symptoms: Sharp pain in the knee, Swelling in the calf, Occasionally, redness of the calf
• Differential Diagnoses: Muscle tears (e.g., proximal Achilles tendon injuries), Deep venous thrombosis
• Other Potential Causes of Calf Pain: Superficial thrombophlebitis, Acute compartment syndrome, Cellulitis, Soft tissue neoplasm, Infection, Aneurysm, Myositis ossificans

 

References

1. Insights Imaging (2013) 4:257–272
2. MRI Web Clinic — September 2013 Proximal Gastrocnemius Tendon Pathology
3. https://radiopaedia.org/articles/baker-cyst-2?lang=us
4. Semin Musculoskelet Radiol 2010;14:162–175

 

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