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Ruptured Baker's cyst: complications due to misdiagnosis
Sergio Tejero1, Blanca T Fenero-Delgado1, Rafael López-Lobato1
1Unidad de Gestión Clínica Cirugía Ortopédica, Traumatología y Reumatología, Hospital Universitario Virgen del Rocío, Sevilla, España.
Insights
Misdiagnosing deep vein thrombosis (DVT) can lead to serious complications. Prompt diagnosis using Doppler ultrasound is crucial to avoid incorrect treatment with low molecular weight heparins (LMWHs), preventing adverse outcomes.
Area of Science:
- Vascular Surgery
- Diagnostic Imaging
- Emergency Medicine
Background:
- Deep vein thrombosis (DVT) and ruptured Baker's cyst share similar calf pain and inflammation symptoms.
- Accurate differential diagnosis is critical due to the risks associated with treating DVT with low molecular weight heparins (LMWHs).
Purpose of the Study:
- To highlight the dangers of misdiagnosing deep vein thrombosis (DVT) in patients presenting with calf pain.
- To emphasize the necessity of Doppler ultrasound in differentiating DVT from other conditions like ruptured Baker's cyst.
Main Methods:
- Retrospective case series of 7 patients.
- Analysis of clinical presentations, initial misdiagnosis of DVT, and subsequent treatment with LMWHs.
- Review of outcomes, including symptom exacerbation and need for surgical intervention.
Main Results:
- All 7 patients were initially misdiagnosed with DVT without Doppler ultrasound confirmation.
- Therapeutic doses of LMWHs were administered, leading to abrupt symptom worsening in all cases.
- Four patients developed compartment syndrome requiring urgent fasciotomy.
Conclusions:
- Failure to utilize Doppler ultrasound for differential diagnosis can lead to inappropriate LMWH treatment.
- Misdiagnosis and subsequent LMWH administration can result in severe complications such as compartment syndrome.
- Timely and accurate imaging is essential for appropriate management of calf pain and swelling.
En:
Deep vein thrombosis (DVT) and ruptured Baker's cyst have similar clinical presentations: inflammation and acute pain in the calf. Differential diagnosis is necessary and requires information from Doppler ultrasound imaging because treating suspected DVT with therapeutic doses of low molecular weight heparins (LMWHs) can cause major bleeding and worsen the prognosis of complicated Baker's cyst. We present a series of 7 consecutive cases in which the patients were misdiagnosed with DVT without imaging. LMWHs were started at therapeutic doses in all cases. The patients' symptoms worsened abruptly after treatment, causing compartment syndrome in the leg. Four of the patients required urgent fasciotomy.