Case Study 1
Fig. 3 - After aspiration procedure
Popliteal Cyst
Ultrasound can not only diagnose the simple cyst, but can also diagnose complex cysts with septations or multilocularity that might hinder draining and prevent injecting material to reach every part of the cyst. Ultrasound can also diagnose cysts with complications, like, ruptured cysts for example.
It goes without saying that Ultrasound guidance facilitates increased injection precision and routinely and safely improves accuracy of needle positioning, decreasing the time of the procedure with nearly no pain apart from the needle prick.
Even if surgery will be the chosen line of treatment, arthroscopic communication enlargement surgery may be an ideal treatment option for popliteal cysts and this procedure is performed Ultrasound-guided.
Fig. 1 - Popliteal cyst with detached hyperechoic debris
Popliteal Cyst
Patient History
42-year-old male with painful swollen left knee.
Procedure
Ultrasound scan of left knee performed using linear transducer 12 MHZ probe.
Clinical Findings
Ultrasound scan of the left knee shows hypoechoic compressible swelling on the posterior aspect of the knee with associated thickening of the synovium.
- Synovitis of the knee.
- Popliteal cyst of the left knee.
Fig. 2.1 - Needle placement for aspiration
Popliteal Cyst
Intervention Procedure
Ultrasound guidance for needle placement for aspiration of the huge popliteal cyst on the posterior aspect of the left knee.
Procedural consent
After discussion of the risks and benefits, the patient elected to proceed with aspiration of the popliteal cyst of the left knee.
Consent was obtained. Patient does not have history of adverse reactions, active infection, or relevant allergies. There was no history erythema warmth, and the skin was clear. The skin was prepped in a sterile fashion. Local anesthetic spray was used in the area of aspiration site using ethyl chloride spray. Aspiration was performed using 21 gauge and aspiration of 70 ml serous effusion was done.
Fig. 2.2 - Needle placement for aspiration
Popliteal Cyst
Post Procedure
Patient demonstrated that he was stable before being allowed to leave the facility. Patient tolerated the procedure without complication. The patient was instructed to call immediately with any signs of infection, fever, or allergic reaction. Patient was also instructed to keep the area clean, dry and covered and to return as instructed.
Fig. 2.3 - Needle placement for aspiration
Popliteal Cyst
Conclusion
Popliteal cyst is an enlargement of the normally present gastrocnemius-semimembranosus bursa in the posteromedial region of the knee. Various treatment modalities are there, ranging from conservative symptomatic treatment, interventional treatment, arthroscopic surgery to open surgical resection. The interventional treatment is a simple, in-office, bedside procedure involving aspiration with or without intra-cyst injection of different materials. Aspiration will lead to immediate reduction of the size of the swelling, significant improvement in knee pain, and improvement in range of motion especially flexion. Elastic compression following aspiration and injection helps to prevent re-accumulation of synovial fluid and promotes adherence of the cyst walls, resulting in increased fibrin adhesion and possible scarring of the space.
Fig. 3 - After aspiration procedure
Popliteal Cyst
Ultrasound can not only diagnose the simple cyst, but can also diagnose complex cysts with septations or multilocularity that might hinder draining and prevent injecting material to reach every part of the cyst. Ultrasound can also diagnose cysts with complications, like, ruptured cysts for example.
It goes without saying that Ultrasound guidance facilitates increased injection precision and routinely and safely improves accuracy of needle positioning, decreasing the time of the procedure with nearly no pain apart from the needle prick.
Even if surgery will be the chosen line of treatment, arthroscopic communication enlargement surgery may be an ideal treatment option for popliteal cysts and this procedure is performed Ultrasound-guided.
Fig. 1 - Popliteal cyst with detached hyperechoic debris
Popliteal Cyst
Patient History
42-year-old male with painful swollen left knee.
Procedure
Ultrasound scan of left knee performed using linear transducer 12 MHZ probe.
Clinical Findings
Ultrasound scan of the left knee shows hypoechoic compressible swelling on the posterior aspect of the knee with associated thickening of the synovium.
- Synovitis of the knee.
- Popliteal cyst of the left knee.
Fig. 2.1 - Needle placement for aspiration
Popliteal Cyst
Intervention Procedure
Ultrasound guidance for needle placement for aspiration of the huge popliteal cyst on the posterior aspect of the left knee.
Procedural consent
After discussion of the risks and benefits, the patient elected to proceed with aspiration of the popliteal cyst of the left knee.
Consent was obtained. Patient does not have history of adverse reactions, active infection, or relevant allergies. There was no history erythema warmth, and the skin was clear. The skin was prepped in a sterile fashion. Local anesthetic spray was used in the area of aspiration site using ethyl chloride spray. Aspiration was performed using 21 gauge and aspiration of 70 ml serous effusion was done.
Fig. 2.2 - Needle placement for aspiration
Popliteal Cyst
Post Procedure
Patient demonstrated that he was stable before being allowed to leave the facility. Patient tolerated the procedure without complication. The patient was instructed to call immediately with any signs of infection, fever, or allergic reaction. Patient was also instructed to keep the area clean, dry and covered and to return as instructed.
Fig. 2.3 - Needle placement for aspiration
Popliteal Cyst
Conclusion
Popliteal cyst is an enlargement of the normally present gastrocnemius-semimembranosus bursa in the posteromedial region of the knee. Various treatment modalities are there, ranging from conservative symptomatic treatment, interventional treatment, arthroscopic surgery to open surgical resection. The interventional treatment is a simple, in-office, bedside procedure involving aspiration with or without intra-cyst injection of different materials. Aspiration will lead to immediate reduction of the size of the swelling, significant improvement in knee pain, and improvement in range of motion especially flexion. Elastic compression following aspiration and injection helps to prevent re-accumulation of synovial fluid and promotes adherence of the cyst walls, resulting in increased fibrin adhesion and possible scarring of the space.
Fig. 3 - After aspiration procedure
Popliteal Cyst
Ultrasound can not only diagnose the simple cyst, but can also diagnose complex cysts with septations or multilocularity that might hinder draining and prevent injecting material to reach every part of the cyst. Ultrasound can also diagnose cysts with complications, like, ruptured cysts for example.
It goes without saying that Ultrasound guidance facilitates increased injection precision and routinely and safely improves accuracy of needle positioning, decreasing the time of the procedure with nearly no pain apart from the needle prick.
Even if surgery will be the chosen line of treatment, arthroscopic communication enlargement surgery may be an ideal treatment option for popliteal cysts and this procedure is performed Ultrasound-guided.
Case Study 2
Fig. 4 - Suprapatellar area - all fluid has been aspirated
Suprapatellar Effusion
Ultrasound is a novel modality that can trace the border of knee effusion and quantitatively measure the amount of the effusion in the suprapatellar pouch and detect synovial hypertrophy and hyper vascularity. It also helps comparing to the other sound knee. Also, if interventional procedures will be decided like aspiration and intra-bursal injection, it goes without saying that ultrasound guidance facilitates increased aspiration/injection precision and routinely and safely improves accuracy of needle positioning decreasing the time of the procedure with nearly no pain apart from the needle prick.
Suprapatellar Effusion
Patient History
42-year-old male with painful swollen left knee, the swelling is mainly on the anterior asset of the knee, around the patella distending of the suprapatellar space. Patient has a restricted range of motion along with pain with ambulation.
Procedure
Representative ultrasound images below depicting the suprapatellar effusion area. Ultrasound scan image of the suprapatellar effusion acquired by placing a linear probe (12 MHZ) longitudinally on the suprapatellar pouch. The effusion area was calculated by tracing the margin of the echo-free space that corresponds with the suprapatellar pouch. During the examination, transducer should be placed on the subject as gently as possible to avoid distorting the acquired area. As per the guidelines, the area of interest - the suprapatellar space of the knee joint in this case, should be scanned in long and short axis views to get the full scanning information.
Fig. 1 - Large Effusion in suprapatellar aera - Long axis View
Suprapatellar Effusion
Interventional Procedure
Ultrasound guidance for needle placement for aspiration of the huge suprapatellar effusion of left knee.
Conclusion
Suprapatellar effusion is the collection of fluid in the suprapatellar area, commonly referred to as “water on the knee”. The suprapatellar area is called suprapatellar space, recess, pouch, or bursa. It’s located above the knee joint line, between the femur and the quadriceps tendon. A bursa in general is a normally present fluid-filled sac that helps to provide a cushion and to reduce friction between the bones, tendons, and ligaments of the joints. The suprapatellar bursa helps to allow the quadriceps tendons to move more easily over the femur on bending the knee. In general, also, bursitis can occur when the bursa becomes inflamed or irritated.
Fig. 2 - Large effusion in the suprapatellar area- short axis view
Suprapatellar Effusion
Suprapatellar bursitis can present in different conditions, either acute, transient, or chronic conditions due to one of the following reasons:
• Inflammation, as part of osteoarthritis, rheumatoid arthritis, or gouty arthritis.
• Trauma, as a result of a direct blow, fall, or injury that leads to sprain, ligament tear, or broken bone in the area of the suprapatellar bursa.
• Overuse: frequent, recurring pressure, overuse, or stress to the area due to activities such as kneeling, jumping, or running, especially in overweight or obese patients.
• Bacterial infection in the knee.
Fig. 3 - Ultrasound guidance for aspiration of suprapatellar effusion
Suprapatellar Effusion
Suprapatellar effusion is diagnosed clinically. Imaging also is needed. Ultrasound is a simple, in-office, bedside imaging modality to help to visualize and diagnose the condition. In ultrasonographic evaluation of suprapatellar effusion, the knee should be put in semi-flexed position maintained by placing a pillow under both popliteal areas; and the probe should be gently placed over the same area at the center and proximal poles of the patella because pressure through the transducers can affect the acquired effusion area. Echo-free space will represent a suprapatellar effusion.
Fig. 4 - Suprapatellar area - all fluid has been aspirated
Suprapatellar Effusion
Ultrasound is a novel modality that can trace the border of knee effusion and quantitatively measure the amount of the effusion in the suprapatellar pouch and detect synovial hypertrophy and hyper vascularity. It also helps comparing to the other sound knee. Also, if interventional procedures will be decided like aspiration and intra-bursal injection, it goes without saying that ultrasound guidance facilitates increased aspiration/injection precision and routinely and safely improves accuracy of needle positioning decreasing the time of the procedure with nearly no pain apart from the needle prick.
Suprapatellar Effusion
Patient History
42-year-old male with painful swollen left knee, the swelling is mainly on the anterior asset of the knee, around the patella distending of the suprapatellar space. Patient has a restricted range of motion along with pain with ambulation.
Procedure
Representative ultrasound images below depicting the suprapatellar effusion area. Ultrasound scan image of the suprapatellar effusion acquired by placing a linear probe (12 MHZ) longitudinally on the suprapatellar pouch. The effusion area was calculated by tracing the margin of the echo-free space that corresponds with the suprapatellar pouch. During the examination, transducer should be placed on the subject as gently as possible to avoid distorting the acquired area. As per the guidelines, the area of interest - the suprapatellar space of the knee joint in this case, should be scanned in long and short axis views to get the full scanning information.
Fig. 1 - Large Effusion in suprapatellar aera - Long axis View
Suprapatellar Effusion
Interventional Procedure
Ultrasound guidance for needle placement for aspiration of the huge suprapatellar effusion of left knee.
Conclusion
Suprapatellar effusion is the collection of fluid in the suprapatellar area, commonly referred to as “water on the knee”. The suprapatellar area is called suprapatellar space, recess, pouch, or bursa. It’s located above the knee joint line, between the femur and the quadriceps tendon. A bursa in general is a normally present fluid-filled sac that helps to provide a cushion and to reduce friction between the bones, tendons, and ligaments of the joints. The suprapatellar bursa helps to allow the quadriceps tendons to move more easily over the femur on bending the knee. In general, also, bursitis can occur when the bursa becomes inflamed or irritated.
Fig. 2 - Large effusion in the suprapatellar area- short axis view
Suprapatellar Effusion
Suprapatellar bursitis can present in different conditions, either acute, transient, or chronic conditions due to one of the following reasons:
• Inflammation, as part of osteoarthritis, rheumatoid arthritis, or gouty arthritis.
• Trauma, as a result of a direct blow, fall, or injury that leads to sprain, ligament tear, or broken bone in the area of the suprapatellar bursa.
• Overuse: frequent, recurring pressure, overuse, or stress to the area due to activities such as kneeling, jumping, or running, especially in overweight or obese patients.
• Bacterial infection in the knee.
Fig. 3 - Ultrasound guidance for aspiration of suprapatellar effusion
Suprapatellar Effusion
Suprapatellar effusion is diagnosed clinically. Imaging also is needed. Ultrasound is a simple, in-office, bedside imaging modality to help to visualize and diagnose the condition. In ultrasonographic evaluation of suprapatellar effusion, the knee should be put in semi-flexed position maintained by placing a pillow under both popliteal areas; and the probe should be gently placed over the same area at the center and proximal poles of the patella because pressure through the transducers can affect the acquired effusion area. Echo-free space will represent a suprapatellar effusion.
Fig. 4 - Suprapatellar area - all fluid has been aspirated
Suprapatellar Effusion
Ultrasound is a novel modality that can trace the border of knee effusion and quantitatively measure the amount of the effusion in the suprapatellar pouch and detect synovial hypertrophy and hyper vascularity. It also helps comparing to the other sound knee. Also, if interventional procedures will be decided like aspiration and intra-bursal injection, it goes without saying that ultrasound guidance facilitates increased aspiration/injection precision and routinely and safely improves accuracy of needle positioning decreasing the time of the procedure with nearly no pain apart from the needle prick.