eMedicine Specialties > Radiology > Musculoskeletal

Baker Cyst: Follow-up

Author: Liem T Bui-Mansfield, MD, Associate Professor, Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
Coauthor(s): Rush A Youngberg, MD, Chief of Musculoskeletal Radiology, Department of Radiology, Madigan Army Medical Center
Contributor Information and Disclosures

Updated: Sep 18, 2009

Intervention

Special Concerns

  • Potential complications of Baker cysts that have been reported in the medical literature are as follows:
    • Pseudothrombophlebitis syndrome (rupture, dissection)
    • DVT
    • Pulmonary embolism
    • Hemorrhage
    • Leaking
    • Infection
    • Posterior compartment syndrome
    • Trapped calcified bodies
  • The most common complication of Baker cyst is the rupture or dissection of fluid into the adjacent proximal gastrocnemius muscle belly, which results in a pseudothrombophlebitis syndrome mimicking symptoms of DVT. The incidence of Baker cyst rupture is 3.4-10%. A ruptured Baker cyst may present as an enlarging mass in the calf.
  • Among patients with symptoms of DVT, the incidence of Baker cysts is 3.1-4.1%; the incidence of patients with a Baker cyst who have coexistent DVT is 0.2-11%. Therefore, a differential diagnosis of Baker cyst should be considered in patients presenting with symptoms that are suggestive of DVT. Once DVT is excluded, the popliteal fossa should be carefully evaluated for a ruptured Baker cyst. Alternatively, if a Baker cyst is observed incidentally on a venous duplex examination, the authors suggest that the radiologist should then search carefully for a coexistent DVT.
  • Because of their anatomic location, Baker cysts can be a risk factor for DVT. Most commonly, the Baker cyst is located between the tendons of the medial head of the gastrocnemius and the semimembranosus bursa. Occasionally, the Baker cyst can be found between the heads of the gastrocnemius muscles. In a series of patients with Baker cyst simulating DVT, all patients demonstrated lateral deviation of the popliteal vein, and 30% of patients revealed compression of the popliteal vein. A report exists of a patient who developed a pulmonary embolism after receiving a diagnosis of Baker cyst and DVT.
  • Posterior compartment syndrome usually is caused by trauma. Rarely, dissection or rupture of a Baker cyst can increase pressure within the deep posterior compartment of the leg, causing posterior compartment syndrome.26 Dissection of Baker cysts can also cause anterior compartment syndrome, depending on the direction of dissection. A Baker cyst usually dissects through the muscles, primarily below the knee. There is evidence that almost one third of dissections are into the thigh.
  • An infected Baker cyst is rare; review of the literature disclosed only 3 occurrences. The infected patients had either fever, an increased white blood cell (WBC) count, or an elevated erythrocyte sedimentation rate.
  • An entity that may mimic an infected Baker cyst is a Baker cyst that contains gaslike lucencies. Only 2 patients have been reported with a gas-containing, noninfected Baker cyst. Both patients had diabetes mellitus and RA. The authors did not suggest a mechanism for the appearance of the gaslike lucencies in the Baker cyst.
  • Jayson and Dixon studied the valvular mechanisms in juxta-articular cysts and postulated that joint effusion and fibrin are pumped from the knee joint into the Baker cyst but—because of a valvelike communication (either a Bunsen or ball valve)—not in the reverse direction (see Image 1).5 The effusion can be readily reabsorbed through the synovial membrane, leaving behind concentrations of fibrin, which on radiographs may appear as gaslike lucencies. In our experience, 1 patient had a noninfected Baker cyst with gaslike lucencies (see Images below), along with diabetes mellitus and RA. Because gaslike lucencies in a Baker cyst are rare and an infected Baker cyst is a serious condition, the former diagnosis must be one of exclusion; a CT scan with appropriate window settings allows discrimination between air and fibrin.



Anteroposterior radiograph of the knee shows mult...

Anteroposterior radiograph of the knee shows multiple tiny lucencies superior to the medial femoral condyle (arrowhead).

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Anteroposterior radiograph of the knee shows mult...

Anteroposterior radiograph of the knee shows multiple tiny lucencies superior to the medial femoral condyle (arrowhead).


Lateral radiograph of the knee shows multiple tin...

Lateral radiograph of the knee shows multiple tiny lucencies (arrowhead) posterior to the knee.

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Lateral radiograph of the knee shows multiple tin...

Lateral radiograph of the knee shows multiple tiny lucencies (arrowhead) posterior to the knee.


Contrast-enhanced, axial computed tomography (CT)...

Contrast-enhanced, axial computed tomography (CT) scan of the knee shows multiple gaslike lucencies within a Baker cyst and synovial enhancement.

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Contrast-enhanced, axial computed tomography (CT)...

Contrast-enhanced, axial computed tomography (CT) scan of the knee shows multiple gaslike lucencies within a Baker cyst and synovial enhancement.


  • Radiographic findings of calcified bodies posterior to the knee joint can be confusing. The differential diagnosis includes soft-tissue neoplasms with calcification (eg, extraskeletal soft-tissue sarcoma), a popliteal artery aneurysm, vascular malformations, and loose, calcified bodies trapped in a Baker cyst. Calcified bodies in Baker cysts are common, with an incidence of 6% in one series.
  • Calcified bodies may derive from trauma (ie, loose bodies resulting from osteochondral fractures), arthropathy (ie, loose bodies associated with joint surface disintegration, such as that related to osteoarthritis, infection, and neuropathic joints), or synovial chondromatosis (that is, calcified or noncalcified bodies resulting from chondrometaplasia of synovial tissue) (see Image 8, Image 9 in Multimedia).
  • Distal migration of loose bodies supports the diagnosis of a dissecting Baker cyst. Rarely, a solitary, calcified, loose body in a Baker cyst may simulate a fabella on the lateral view of conventional radiography of the knee (see Image 10, Image 11 in Multimedia). However, on the frontal view, a fabella is located in the lateral head of the gastrocnemius muscle, while a calcified, loose body in a Baker cyst is located medially.
 


More on Baker Cyst

Overview: Baker Cyst
Imaging: Baker Cyst
Follow-up: Baker Cyst
Multimedia: Baker Cyst
References
Further Reading
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References

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Further Reading


Related eMedicine topics

 Osteoarthritis

Neuropathic Arthropathy (Charcot Joint)

Arthrocentesis, Knee

The Approach to the Painful Joint

Patellofemoral Joint Syndromes

Cystic Lesions About the Knee 
 
Knee Injury, Soft Tissue

Clinical guideline

 Ultrasonographic examinations: indications and preparation of the patient.
Finnish Medical Society Duodecim - Professional Association. 2000 Apr 18 (revised 2007 Jan 11). Various pagings. NGC:005501


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Keywords

Baker cyst, Baker's cyst, popliteal cyst, popliteal bursa, gastrocnemio-semimembranosus bursa, gastrocnemio-semimembranous bursa, gastrocnemiosemimembranosus bursa, gastrocnemiosemimembranous bursa

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Contributor Information and Disclosures

Author

Liem T Bui-Mansfield, MD, Associate Professor, Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
Liem T Bui-Mansfield, MD is a member of the following medical societies: American Roentgen Ray Society, Radiological Society of North America, and Society of Skeletal Radiology
Disclosure: Nothing to disclose.

Coauthor(s)

Rush A Youngberg, MD, Chief of Musculoskeletal Radiology, Department of Radiology, Madigan Army Medical Center
Disclosure: Nothing to disclose.

Medical Editor

David S Levey, MD, PhD, Orthopedic/Spine MRI TeleRadiologist, Radsource, LLC
David S Levey, MD, PhD is a member of the following medical societies: American Roentgen Ray Society, Radiological Society of North America, and Texas Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Javier Beltran, MD, Chair, Department of Radiology, Maimonides Medical Center
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Resolution Imaging Medical Corporation
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Felix S Chew, MD, MBA, EdM, Professor, Department of Radiology, Vice Chairman for Radiology Informatics, Section Head of Musculoskeletal Radiology, University of Washington
Felix S Chew, MD, MBA, EdM is a member of the following medical societies: American Roentgen Ray Society, Association of University Radiologists, and Radiological Society of North America
Disclosure: Nothing to disclose.

 
 
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