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Popliteal Cyst in Children

SUMMARY

  • Popliteal Cysts are common soft tissue masses in children that unlike the adult population, are most often not associated with meniscal tears. 

  • Diagnosis is suspected clinically with a palpable mass in the popliteal fossa that transilluminates. MRI can confirm the diagnosis of a cystic lesion. 

  • Treatment is observation as the majority of lesions spontaneously resolve. 

ETIOLOGY

  • Pathoanatomy

    • popliteal cysts usually are located

      • between muscles of

        • semimembranosus

        • medial head of gastrocnemius

      • from herniated posterior knee joint capsule synovium

ANATOMY

    • Muscles posterior to medial knee capsule

      • semimembranosus 

      • medial head of gastrocnemius 

PRESENTATION

  • Symptoms

    • usually asymptomatic

  • Physical exam

    • located in popliteal fossa

      • usually located medially and distal to knee crease

        • most pronounced with knee extended

    • mass will transilluminate

IMAGING

  • Radiographs

    • are normal

  • Ultrasound

    • consistent with cystic lesion

  • MRI

    • show fluid filled cyst

TREATMENT

  • Nonoperative

    • observation

      • indications

        • mainstay of treatment

          • with majority of cases resolving spontaneously 

             

  • Operative

    • excision

      • indications

        • only if cyst causes significant discomfort

        • failure of spontaneous resolution

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