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676 - Management of a Complex Leaking Popliteal Cyst: A Case Report

Thursday, February 27, 2025

5:00 PM - 6:30 PM MST

Presenting Author(s)

IR

Isha Rao, DO

PGY3, Resident Physician
SUNY - - Brooklyn, NY
Brooklyn, New York, United States

Co-Author(s)

PJ

Panayotis Jusakos, MD

PMR Resident
One Brooklyn Health
orlando, Florida, United States
SG

Simron Gill, MD

Resident
SUNY Downstate Health Sciences University
New york, New York, United States
MR

Marc Ross, MD

Director inpatient Rehabilitation Medicine
Downstate medical Center
Brooklyn, New York, United States
Sanjeev Agarwal, MD

Program Director
SUNY Downstate Health Science University
Brooklyn, New York, United States

Case Diagnosis: Complex Leaking Popliteal Cyst

Case Description: A 35 year old male with scoliosis and Arnold Chiari syndrome presented with a two-month history of swelling on the medial aspect of his right knee concerning for a cyst. The swelling developed spontaneously, worsening over the first week, until it stabilized in size. There was no reported history of trauma. Despite the cyst’s large size, range of motion was preserved with no associated pain or discomfort. There were no associated symptoms of fever, chills, eryhtema, or other signs of infection. An MRI of the right knee revealed a large, complex, leaking popliteal cyst with intact ligaments and menisci. Ultrasound imaging was used to visualize the cyst, which showed heterogenous echogenicity and a thickened border around the cyst, consistent with the diagnosis of a complex cyst.

Discussions: A challenge in managing popliteal cysts is the potential for recurrence. Research shows that after aspiration and steroid injection for treatment of complex popliteal cyst there was a recurrence rate of 18.75%. Younger patients, such as in this case, typically have lower recurrence rates. Elastic compression post-aspiration has been shown to help decrease the likelihood of recurrence. Literature supports conservative approaches for an asymptomatic popliteal cyst such as activity modifications, rehabilitation, non-steroidal anti-inflammatory medications, or ultrasound guided aspiration. In cases complicated by meniscal tears or infection, arthroscopic surgery may be indicated. Given the characteristics and symptoms presented in this case, a referral to orthopedics was made for aspiration of the popliteal cyst to address the issue effectively and prevent further complications.

Conclusions: Early diagnosis and management of a complex leaking popliteal cyst are critical to prevent complications such as rupture, infection, intramuscular dissections, ligamentous disruption, and/or venous obstruction. Aspiration of a large, complex cyst is an effective method to manage symptoms and lower risk of recurrence.