09/07/2024
An Intriguing Case from My Residency: A Record-Breaking Baker's Cyst
Today, I’m excited to share an interesting case I encountered during my residency. This involves a Baker's cyst, which you can see in Figure 1.
A Baker's cyst, also known as a popliteal cyst, is an abnormal swelling of the gastrocnemius-semimembranosus bursa. This occurs due to fluid leakage from the knee joint into the bursa. It's one of the most common cystic lesions found around the knee joint.
Case Presentation:
A 35-year-old woman, who has been suffering from rheumatoid arthritis for the past five years, came to our outpatient department. She complained of pain and swelling at the back of her left knee, which had persisted for the last six to eight months.
While conducting a literature review for this case, my team and I discovered three significant points:
1. Our case involved one of the largest Baker's cysts reported to date.
2. We identified a new classification for infected Baker's cysts (see Figure 2).
3. There were hardly any documented cases of Baker's cysts in Pakistan.
Additionally, we found eight cases where Baker's cysts extended into nearby muscles, including the vastus medialis and the medial head of the gastrocnemius.
Treatment:
Various conservative and operative interventions are mentioned in the literature. Conservative treatments include aspiration, corticosteroid, and methotrexate injections (the latter being an alternative for patients at high risk for surgery). Bandinelli et al. documented satisfactory outcomes using ultrasound-guided direct steroid injections into the cyst and intra-articular steroid injections in similar situations. Acebes et al. reported positive outcomes for osteoarthritis patients after aspirating cyst contents and injecting KS.
In our case, the patient was symptomatic and had already undergone multiple aspirations. Therefore, we opted for open excision. Our results favored this approach, aligning with other successful cases of open excisional management.
I'm thrilled to share that we successfully published this case in the international journal *Revista Brasileira de Ortopedia*.
Took me more than 10 months journal was quite slow in case reports.
Special thanks to Prof. Adeel Ahmed and our exceptional Civil hospital Ward team for their outstanding performance during the surgery.
To appreciate the size of this Baker's cyst, note its comparison with a kidney tray, measuring a remarkable 25 cm.
