Soriano E R, Catoggio L J
Medical Services, Hospital Italiano de Buenos Aires, Argentina.
Clin Exp Rheumatol. 1990 Mar-Apr;8(2):107-12.
The diagnostic approach and therapeutic attitudes to be assumed when facing the dilemma of deep vein thrombosis versus a complicated Baker's cyst remain unclear. We examined our own approach with 16 Baker's cysts [11 presenting with a "thrombophlebitis picture" (TP)] recently diagnosed in our services, and reviewed the literature. All of our patients had an underlying joint disorder and previous knee effusions. The diagnostic approach (i.e., the request or not for venography) was related to the specialty of the physician who saw the patient first. The results of the venography led to anticoagulation treatment in 5 of the 6 patients on whom it was performed, although these patients did not otherwise differ from those with a similar clinical picture in whom no venogram was obtained. Arthrograms performed early after onset of the TP were more likely to reveal cyst rupture. The recent literature does not mention serious venous complications (in particular, pulmonary embolism) in patients in whom only the cyst was treated, without knowledge of possible coexisting venous occlusions. The need to perform venography, the importance of the localisation of the occlusions and the therapeutic consequences are discussed and a proposal is made to study these patients in a systematic way in order to better understand the inter-relationship between complicated popliteal cysts and venous alterations, and to decide the best approach to assume in the future.
面对深静脉血栓形成与复杂性腘窝囊肿这一困境时应采取的诊断方法和治疗态度仍不明确。我们研究了我院近期诊断的16例腘窝囊肿（其中11例表现为“血栓性静脉炎样表现”[TP]）的处理方法，并复习了相关文献。我们所有的患者均有潜在的关节疾病且既往有膝关节积液。诊断方法（即是否要求进行静脉造影）与首位接诊医生的专业有关。6例行静脉造影的患者中有5例因造影结果接受了抗凝治疗，尽管这些患者与未行静脉造影但临床表现相似的患者并无其他差异。TP发作后早期进行的关节造影更有可能显示囊肿破裂。近期文献未提及仅治疗囊肿而未了解可能并存的静脉闭塞的患者发生严重静脉并发症（尤其是肺栓塞）的情况。本文讨论了进行静脉造影的必要性、闭塞部位的重要性及治疗后果，并提出以系统的方式研究这些患者，以便更好地理解复杂性腘窝囊肿与静脉改变之间的相互关系，并确定未来最佳的处理方法。
