Diagnosis of a Baker cyst in a child
The diagnosis can be made on the basis of the palpation findings, the symptoms that occur and an ultrasound examination. This relatively simple procedure is usually sufficient for children. From a diameter of two centimetres, the palpation findings are clear.
Smaller variants can also be detected by ultrasound, but also by magnetic resonance imaging (MRI). The ultrasound provides information about the volume and spread of the cyst. MRI is rarely used in the diagnosis of classic Baker’s cyst.
In the case of a pseudocyst it provides additional information regarding the underlying disease and signs of wear. However, an MRI examination can be helpful in distinguishing a Baker’s cyst from a sarcoma. If radiological suspicion of sarcoma exists, the diagnosis is confirmed by means of a tissue sample. A malignant event in the form of a tumour, haematomas, venous sacculation and thromboses should be excluded by differential diagnosis in all cases.
Therapy of a Baker cyst in a child
In many cases, the Baker’s cyst recedes of its own accord in children and does not require any further therapy. Conservative measures include taking anti-inflammatory medication. Preparations containing cortisone are controversial in their application.
Particularly large cysts can be drained by means of puncture if there are existing symptoms. These can be movement restrictions, paralysis or pain. To do this, the treating physician punctures the sac under sterile conditions and withdraws the fluid contained.
Alternatively, there is the possibility of surgical removal. The operation of a Baker’s cyst in children is only considered in rare cases. After surgical visualization of the cyst, the connection between cyst and joint capsule is removed.
It is then cut out and the capsule is sutured. This serves as a preventive measure against the formation of a new cyst. After the operation, the leg is elevated and cooled.
A plaster or splint is also used for immobilisation. After three days, passive mobilisation is started and after seven days the active movement of the knee joint begins. The minimally invasive technique is not used in children. After every tenth operation the cyst reappears. While the causes in adults have been clarified, there is still no sufficient explanation for the reappearance of the Baker’s cyst in children.
Forecast
In general, the prognosis of Baker’s cyst in children is good. Often it recedes spontaneously in childhood and an observational procedure can be chosen. Puncture as a therapeutic measure for large cysts does not guarantee the disappearance of the cyst. A recurrence should be expected.
Prophylaxis
Since the Baker cyst is congenital in children, it cannot be prevented causally.
