Letter: Infusion thrombophlebitis.
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43 non-surgical patients presenting with calf pain and a clinical diagnosis of deep venous thrombosis (DVT) were studied by arthrography, venography, and ultrasound. Only 14 had venographic evidence of DVT; 5 of these had popliteal cysts, which in 4 cases probably contributed to symptoms. 11 patients had popliteal cysts and normal venograms, and 9 of these cysts were thought likely to be the cause of the symptoms. In 18 patients all investigations were normal. Physical signs were not helpful in distinguishing between the three groups of patients. Ultrasonography detected only 2 of the 16 popliteal cysts. Popliteal cysts should be considered in the differential diagnosis and as a possible coexisting condition in patients suspected clinically of having DVT. Also, the finding of a Baker's cyst should not deter one from doing a venogram.
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A patient with psoriatic arthritis presented to the Geisinger Medical Center emergency department after the sudden onset of pain and swelling in his left calf. Initially, the patient was thought to have acute thrombophelebitis. Upon further examination, the diagnosis of a ruptured popliteal cyst was considered, and was confirmed with arthrography. The case illustrates an occurrence of a dissecting popliteal cyst simulating an cute deep vein thrombosis in a patient with an inflammatory process involving the knee.
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The patient presenting to the emergency department (ED) with a painful swollen lower extremity is considered to have deep venous thrombosis (DVT) until this diagnosis can be ruled out. This clinical presentation, however, is far from specific and the differential diagnosis includes symptomatic Baker's cyst, also known as pseudothrombophlebitis syndrome (PTP). This article presents two cases of PTP and reviews the literature relevant to diagnosis of DVT and PTP. Ultrasonography is now the diagnostic test of choice for both DVT and PTP, being safe, accurate, noninvasive, and rapid, and should ideally be available for use in the ED.
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