1. Deep Venous Summit Clinical Case Unilateral limb swelling
Nicos Labropoulos Professor of Surgery and Radiology Director, Vascular Laboratory Division of Vascular Surgery Stony Brook University Medical Center Stony Brook, NY

2. Disclosures Cook Philips IGT Speaker, received honoraria
Dr. Labropoulos has received compensation from Philips IGT for his time to prepare and deliver this presentation
The content of this presentation was independently prepared.  The opinions expressed herein are those of the presenter and are not necessarily indicative of the views of any other party

3. Male 46 years old presented with pain and swelling
Pain started a week ago at the posteromedial knee
In a period of a 3 days he developed significant swelling
from the knee to the ankle.
The swelling was getting progressively worst until he came
at the ER 7 days later.
No history of thrombosis, trauma or surgery
No medications
He was sent to have a left lower extremity venous ultrasound.

4. Limb asymmetry

5. Pain and swelling

6. Pain and swelling
Became progressively worse

7. What would do next? CT venogram of abdomen and pelvis
Lower extremity venous ultrasound
D-dimer
Venography

8. What would do next? CT venogram of abdomen and pelvis
Lower extremity venous ultrasound
D-dimer
Venography

9. There was no deep vein thrombosis

10. Mass in the popliteal fossa

11. Fluid at the ankle level
Upper
Lower

12. Fluid in the knee joint
Compression
of the fluid

13. Comparison between the left and right knee

14. Compression of the popliteal vein, the artery is normal

15. Compression of the left popliteal vein

16. What is the pathology seen by ultrasound?
Hematoma
Adventitial cyst
Tumor
Baker cyst

17. What is the pathology seen by ultrasound?
Hematoma
Adventitial cyst
Tumor
Baker cyst

18. Adams R. Arthritis, chronic rheumatic, of the knee joint
Adams R. Arthritis, chronic rheumatic, of the knee joint. Dublin J Med Sci 1840;17:520–23
Baker WM. On the formation of synovial cysts in the leg in connection with disease of the knee joint.
St Bartholomew’s Hospital Reports 1877;13:245–261
Labropoulos N, et al. New insights into the
development of popliteal cysts.
Br J Surg 2004;91:1313–18
Popliteal cysts form in the posteromedial popliteal fossa because the synovial capsule does not provide anatomical support in this region.

19. Popliteal vein compression most common with or without thrombosis
Sanchez JE, Conkling N, Labropoulos N.
Compression syndromes of the popliteal neurovascular bundle due to Baker cyst. J Vasc Surg 2011;54:1821-9
Popliteal vein compression most common
with or without thrombosis
Tibial nerve compression
Popliteal artery compression
Rare
Compartment syndrome

20. Hemorrhagic popliteal cyst
M 57 years old
Right lower limb swelling and pain that became progressively worst in the last 2 days
No varicose veins
No DVT
Hemorrhagic popliteal cyst
Significant compression of the popliteal vein and tibial nerve
Sanchez JE, Conkling N, Labropoulos N.
Compression syndromes of the popliteal neurovascular bundle due to Baker cyst. J Vasc Surg 2011;54:1821-9

21. 73 cases in 30 publications Nerve compression 17 Tibial 13
Sanchez JE, Conkling N, Labropoulos N.
Compression syndromes of the popliteal neurovascular bundle due to Baker cyst. J Vasc Surg 2011;54:1821-9
73 cases in 30 publications
Nerve compression 17
Tibial 13
Common peroneal 2
Sciatic 1
Popliteal vein compression 47
Popliteal artery compression 5
Compartment syndrome 4

22. Sanchez JE, Conkling N, Labropoulos N.
Compression syndromes of the popliteal neurovascular bundle due to Baker cyst. J Vasc Surg 2011;54:1821-9
Baker cyst is an important pathology for the differential diagnosis of popliteal neurovascular compression phenomena.
It has a wide spectrum of presentation, therefore requiring accurate diagnosis for proper patient management.
Because Baker cyst is by definition a chronic disorder, long-term follow-up is necessary to monitor patient recovery and prevent recurrence.