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Mardiyeva Gulshod Mamatmurodovna, Candidate of Medical Science, Associate Professor, Head of the Department of Radiation Diagnostics and Therapy
Samarkand State Medical Institute, E-mail: [email protected] Khamidov Obit Abduraxmanovich, Head of the Department of X-ray Radiology 1-clinic of Samarkand State Medical Institute, E-mail: [email protected] Yakubov Doniyor Javlanovich, resident of magistracy, radiation diagnosis and therapy Samarkand State Medical Institute, E-mail: [email protected] Turdumatov Jamshed Anvarovich, Assistant, of the Department of Radiation Diagnostics and Therapy Samarkand State Medical Institute E-mail: [email protected]
ULTRASOUND SEMIOTICS OF BIKER CYSTS
Abstract. The ultrasound data of 80 patients with Baker cysts aged 10 to 60 years were analyzed. Baker's cyst was visualized in the form of a distended fluid of the synovial bag of the popliteal fossa and was very often combined with various pathologies of the knee joint. Synovial cysts of the subcortical region are pathological formations that have arisen as a result of the influence of polythetic factors causing chronic irritation of the synovial membrane of the knee joint and synovial bags.
Keywords: Baker's cyst, arthrosonography, knee joint.
The anatomical diversity of the popliteal region, the abun- an intra-articular effusion, the synovial membrane were evalu-dance of mucous bags in terms of the differential diagnosis of ated. The dorsal part of the knee joint, where Baker's cyst is their pathological conditions presents certain difficulties for located, was examined in the position of the patient lying on the clinician. However, Baker's cyst is not such a rare disease his stomach. The study was carried out in the transverse and and accounts for 3.9% of all injuries and diseases of the knee longitudinal directions in many sections of the entire dorsal joint [1; 2; 5]. surface of the knee joint with the proximal part of the leg and
In connection with the expansion of indications for ad- the distal part of the thigh, in the position of extension and equate surgical interventions on the knee j oint, especially in its flexion of the knee joint.
posterior part, arthrosonography is currently gaining interest. The results of the study. In the examined patients with
At the present level of knowledge, sonography, as a non-invasive knee joint pathologies, in the history ofwhich different types method of research, has become more important in the diagno- of knee injuries were noted, a Baker cyst was revealed in 80 sis of Baker cysts with a high degree of reliability [3; 4]. patients. The duration of the disease in the examined patients
Considering the above, the purpose of our study is to ranged from one to six years. Mostly the cyst was noted in the study the ultrasound semiotics of Baker's cyst. left knee joint, which made 50% (40 patients). In 24 patients
Material and methods. The data of an ultrasound study (30%) left-sided localization was observed, and in 20% of of 80 patients with Baker's cysts aged from 10 to 60 years were cases (16 patients), bilateral cyst localization was observed. analyzed using a SonoScape-S-50 ultrasound scanner with a During ultrasound examination, Baker's cyst was visual-
linear format sensor with an operating frequency of 7.5 MHz. ized as a stretched by fluid synovial bag of the popliteal fossa, The study was performed in the position of the patient ly- located in its medial section between the inner head of calf and ing on his stomach and on his back, necessarily in comparison semi-membranous muscles and communicating with the knee with the intact side. In the position of a patient lying on his joint by means of fistula. Baker cyst of small size usually had back, the state of the upper inversion, its size, the presence of a painless course. With relatively large sizes of cysts, patients
ULTRASOUND SEMIOTICS OF BIKER CYSTS
mostly complained of sensation of pain along the posterior surface of the knee joint during physical exertion, discomfort, and the presence of a tumor-like mass in the subtile fossa. The of symptoms complex sometimes included pain in the calf muscles or impaired sensitivity along the back of the leg.
In the popliteal area, all patients were found to have different sizes of clearly defined low-painful elastic swelling, disappearing or diminishing in size when the knee joint was bent at rest and increased after physical exertion.
In ultrasound of symptoms Baker cyst is often combined with various pathologies of the knee joint. Thus, in 17.5% of cases (14 patients), sonographic symptoms of arthritis were marked, in which Baker's cysts are often visually obliterated, and in the presence of effusion, they are prone to rupture due to marked degenerative changes in the walls. Determining the severity of intraarticular effusion according to ultrasound data, as a rule, presents no difficulty [4; 5] if the border between the fluid layer and the hypoechoic thickened synovial membrane is clearly visible.
In addition to marked hyperplasia of the synovial membrane in the upper torsion and in Baker's cysts, significant thickening of the synovial membrane in the infrapatellar zon in the area of the fat body and pterygoid folds is typical for arthritis. When scanning the infrapatellar zone of a bent more than 90° of knee joint, a typical symptom is noted - the hypoechoic layer of the thickened synovial membrane over the supporting surface of the articular cartilage, which was not noted by us in any other diseases.
In 10 patients (12.5%), gonarthrosis was diagnosed predominantly of the first and second stages of degenerative-dystrophic changes on the part of the articulating surfaces of the knee j oint and was characterized by the formation of small hyperachroic marginal osteophytes of the fibrocartilaginous echo structure, with the normal size of the joint space and the thickness of hyaline cartilage;
In combination with a Baker cyst, the states of the upper synovial twisting of the knee joint are typical for gonarthrosis, indicating a different degree of obliteration or an increase in its volume, especially with synovitis revealed in 8 cases (10%). Also, in 8 observations (10%) ultrasound signs of bursitis were noted. Prepatellary bursitis is a frequent complication that occurs after injuries of the knee joint, especially the anterior sections and the patella, with a tendency to chronicity. Almost always there was swelling of the subcutaneous fatty tissue over the entire front surface of the knee j oint with hypoechoic layers between the segments of adipose tissue, and therefore it was not possible to determine the boundaries of the bag at times.
Sinovitis is a provocative moment in the development of cysts, leading to increased intra-articular pressure, which increases the risk of developing of recurrences. Constant stimu-
lation of the synovial membrane and accumulated fluid stretch the synovial sac, forming a cyst, and its size can reach large sizes (12 x 8 x 6 cm).
As shown by our research, Baker cyst formation occurs in stages. We have identified 3 periods of the sonographic organization of cysts. In the first period - early structural changes -the cyst had a wall up to 2.6 mm thick, without intralumi-nal structures. In longitudinal scanning, an oval-shaped cyst with homogeneous anechoic contents was determined. These changes were noted in 26 patients (32.5%). The second period - the progression of structural changes - was characterized by a thickening of the cyst wall up to 7.9 mm, a heterogeneous content structure with "gentle" septa and inclusions. In the study of the popliteal fossa, a cyst, divided by a semimembra-nose, having a crescentic shape during transverse scanning, was visualized in the form of two longitudinal elongated ellipses with longitudinal scanning. These changes were noted in 30 patients (31.5%). In the third period - the final structural organization - the walls of the cyst are thicker than 8.0 mm, in the cavity there were septa and inclusions with a small amount of "liquid" content, which we found in 24 patients (30%).
The earliest stage of the cyst was a type of hernia of the synovial sac. Hernia of the synovial sac occurred in 15% of cases. Light signs of knee joint synovitis have always been identified. The later bursitis stage of the cyst occurred in most cases (85% of cases). There have always been marked signs of chronic synovitis of the joint.
3 patients (3.75%) had a Baker cyst that communicates with the joint cavity through the fistula. In the predominant percentage of observations (80%), single-chamber formation was characteristic. In 16 cases (20%), multi-chamber Baker cyst was revealed. In rare cases, in sonography connective tissue bridges in the cavity of cystic formations, were differentiated with a small amount of "liquid" content and a wall thickness of more than 8 mm, which is typical of the inflammatory process.
In chronic inflammation of the cyst (35% of observations) on the arthrosonogram, an echo-negative formation with clear contours, a moderately increased echogenicity of the synovial membrane, thickened to 6-8 mm, with villi and single soft septa was visualized on the arthrosonogram. The content presented inhomogeneous, with echo dense, without acoustic shadow, inclusions. The neck of the cyst was less clear.
Interpretation of the results of the study showed that in 35% of observations (28 patients) there was a combination of several pathologies, against the background ofwhich Baker cyst was differentiated.
As can be seen, synovial cysts of the subcortical region are pathological formations resulting from the influence of polythetic factors that cause chronic irritation of the synovial membrane of the knee joint and synovial bags. Cysts
are formed from the popliteal pits or are formed as "hernial" protrusions of the synovial membrane through the weakened areas of the fibrous capsule of the knee joint. The basis of the pathological process is a chronic productive inflammation. It should be noted that this pattern was combined with ultrasound signs of arthritis in 14 cases (17.5%).
Thus, ultrasound examination makes it possible to establish the presence of a Baker cyst, which is increasingly found in the practice of a rheumatologist, its location in the popliteal fossa, to visualize the contours and contents, boundaries and extent, connection with the joint cavity of the, signs of rupture and inflammation of the wall, and also ultrasound signs of damage to the intra-articular structures of the knee joint. Ultrasound makes it possible to establish a link between the stage of gonarthrosis and the stage of the structural organization of the cyst, which consists in the fact that with an increase in the severity of degenerative processes in the tissues of the knee joint, the severity of structural changes in Baker's cyst increases. When examining the popliteal area, ultrasound is
necessary not only to diagnose cystic formations, but also to identify the following common pathological conditions, such as deep vein thrombosis (thrombophlebitis), femoral and popliteal aneurysms, abscesses, tumors, and muscle ruptures.
Conclusions. Ultrasonography with high settling is not inferior to magnetic resonance imaging in the diagnosis of Baker cysts, and taking into account the possibility of choosing the scanning plane, conducting a polypositional study, portability and accessibility, relatively low cost, no contraindications, ultrasound can be considered the optimal method of diagnosis and dynamic observation of patients with Baker cyst, including the course of treatment.
Due to the new high-informative ultrasound devices with broadband high-frequency ultrasound sensors and taking into account non-invasiveness, lack of radiation load, efficiency, availability and lack of contraindications to sonography, this method can be recommended as mandatory in patients suspected of injury and disease of the knee joint and especially if they have cystic formations.
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