Word of the day: Baker Cyst

Examples of Baker Cyst
Variety of sonographic characteristics

Today’s Word of the day is Baker Cyst or popliteal cyst is commonly seen in patients over 50 years of age and occurs when there is a distention of the semimembranosus-medial gastrocnemius bursa.  Baker cyst occurs due to local irritation or inflammation, but most often is associated with fluid accumulation through communication with the knee joint.

A Baker cyst can have a variety of ultrasound characteristics ranging from anechoic to more complex fluid representing hemorrhage or synovial hypertrophy.  Accurate diagnosis of a Baker cyst requires identification of the channel between the semimembranosus and the medial head of the gastrocnemious tendon, which connects the bursa to the knee joint via the subgastrocneumius bursa. This appears as a C-shaped fluid collection that wraps around the medial head of the gastrocnemius tendon and muscle.

To learn more about Baker Cyst, and how to identify it during your evaluations, check out upcoming MSK Hands-On Training Course that will provide hours of hands-on scanning.

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Case report: lower extremity deep vein thrombosis following an intense calf workout

By Yim ES, Friedberg RP.

Source

  1. Harvard Affiliated Emergency Medicine Residency, Beth Israel Deaconess Medical Center, Boston, MA;
  2. Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA; and
  3. Department of Orthopedic Surgery, Harvard Medical School, Boston, MA.

Abstract

We report a case of a high-performance athlete with hemoglobin SC who presented with asymmetric calf soreness after an intense calf workout. By ultrasonography, he was diagnosed with a deep vein thrombosis (DVT) of his right calf. Subsequently he presented with a number of sequelae of sickle cell disease: acute chest syndrome, avascular necrosis of the hips, and chronic kidney disease. The case is instructive as an example of DVT after exercise of the lower extremities, which has not been documented well. The case also illustrates a number of health sequelae of sickle cell disease that mimic more common musculoskeletal complaints. Sports medicine providers will have to consider these uncommon but profound diagnostic entities when caring for athletes with sickle cell disease. The case further highlights how research can inform the clinical decisions and policies aimed at reducing the risk of life-threatening and lifelong sequelae of sickle cell disease in athletes.

Check out the full article on pubmed.gov

Accuracy of Point-of-Care Ultrasonography for Diagnosis of Elbow Fractures in Children

Source

Department of Pediatrics, Division of Pediatric Emergency Medicine, Children’s Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, NY. Electronic address: jrabiner@montefiore.org.

Abstract

STUDY OBJECTIVE:

We determine the test performance characteristics for point-of-care ultrasonography performed by pediatric emergency physicians compared with radiographic diagnosis of elbow fractures and compare interobserver agreement between enrolling physicians and an experienced pediatric emergency medicine sonologist.

METHODS:

This was a prospective study of children aged up to 21 years and presenting to the emergency department (ED) with elbow injuries requiring radiographs. Before obtaining radiographs, pediatric emergency physicians performed focused elbow ultrasonography. An ultrasonographic result positive for fracture at the elbow was defined as the pediatric emergency physician’s determination of an elevated posterior fat pad or lipohemarthrosis of the posterior fat pad. All patients received an elbow radiograph in the ED and clinical follow-up. The criterion standard for fracture was fracture on initial or follow-up radiographs.

RESULTS:

One hundred thirty patients with a mean age of 7.5 years were enrolled by 26 sonologists. Forty-three (33%) patients had a radiograph result positive for fracture. A positive elbow ultrasonographic result had a sensitivity of 98% (95% confidence interval [CI] 88% to 100%), specificity of 70% (95% CI 60% to 79%), positive likelihood ratio of 3.3 (95% CI 2.4 to 4.5), and negative likelihood ratio of 0.03 (95% CI 0.01 to 0.23) for fracture. The interobserver agreement (κ) was 0.77. The use of elbow ultrasonography would reduce radiographs in 48% of patients but would miss 1 fracture.

CONCLUSION:

Point-of-care ultrasonography is highly sensitive for elbow fractures, and a negative ultrasonographic result may reduce the need for radiographs in children with elbow injuries. Elbow ultrasonography may be useful in settings in which radiography is not readily accessible or is time consuming to obtain.

Copyright © 2012. Published by Mosby, Inc.

Check out the full article on pubmed.gov