R.E: Interesting case of Bakers cyst Intramuscular Extension

[Paige Chong]

Hi Steve

How can we differentiate this bakers cyst intramuscular extension from an intramuscular hematoma or abscess?

Regards,
Paige

[Stephen Bird]

Hi Paige,

Yes, I would think those things could look similar, but I think we can tell them apart.

The history is probably the biggest key,

A haematoma would require trauma or anticoagulation.

An abscess would be a very sick, febrile and septic patient.

In these cases there was just progressive calf swelling.

Another clue is that a calf tear of medial gastroc doesn’t happen at this location. They always tear from the aponeurosis deep to the muscle. I have not seen a tear that sits just under the superficial muscle fascia. When I see fluid here I think of a Bakers cyst extension.

Also, you can carefully track the collection back to a neck which terminates at exactly the right spot for a Bakers cyst between medial gastroc and semimembranosus.

Steve

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