DVT and Baker's cyst: both may occur together.

Clinical bottom line (level 1b)

  1. Baker's cysts (37%) and DVT (33%) were common in patients presenting with a possible deep vein thrombosis.
  2. Both were present together in 36% cases
  3. A Baker's cyst is more likely in patients with a history of arthritis (LR+3.0) or who have crepitus on flexing their knee (LR+3.4) .
Simpson et al: Lancet 1980; 1: 331-333
Expires May 2004

The study

Setting: university hospital, UK

43 patients (aged range 17 to 86 years; mean 51, 60% female) suspected deep vein thrombosis

Excluded if
  • general anaesthetic within four weeks



    • Independent blinded reference standard, applied in all patients from a consecutive appropriate spectrum.
    Reference standard:
    • venogram interpreted by two blinded reviewers; arthrography of the knee (single contrast: AP had lateral view): positive if cyst> 5 cm seen. Cyst ruptured if loss of outline and extravasation of contrast into fascial planes around knee)
    Diagnostic test: 1. ultrasound scan; 2. history and examination

    The evidence

    pre-test probability of deep vein thrombosis: 33%, (95% CI: 19% to 47%)
    pre-test probability of Baker's cyst: 37%, (95% CI: 23% to 52%)

    diagnostic test Baker's cyst no Baker's cyst LR+
    (95% CI)    		 post-test probability LR-
    (95% CI)    		 post-test probability
    crepitus on flexing knee 9 5 3.0
    (1.2 to 7.5)     		64% 0.54
    (0.30 to 0.96)     		24%
    history of arthritis 8 4 3.4
    (1.2 to 9.4)     		67% 0.59
    (0.35 to 0.98)     		26%
    ultrasound scan (2.5 MHz probe) 2 0 inf
    (0.16 to inf)     		100% 0.88
    (0.73 to 1.1)     		34%
    total 16 27


    diagnostic test DVT no DVT LR+
    (95% CI)    		 post-test probability LR-
    (95% CI)    		 post-test probability
    Baker's cyst 5 11 0.94
    (0.41 to 2.2)     		31% 1.0
    (0.64 to 1.7)     		33%
    ruptured Baker's cyst 2 3 1.4
    (0.26 to 7.4)     		40% 0.96
    (0.75 to 1.2)     		32%
    total 14 29

    Comments

    1. Ultrasound scan technoilogy has advanced considerably since this study.
    2. The study is too small to indicate whether the presence of a ruptured Baker's cyst makes a DVT less likely.

    Citation

    1. Simpson FW, Robinson PJ, Bark M, et al: Prospective study of thrombophlebitis and 'pseudothrombophlebitis'. Lancet 1980; 1: 331-333
    Contributor: Chris Ball and Clare Wotton, May 2000
    Reviewer: Alex Gallus

    Clinical Question.
    Patient suspected DVT
    Intervention or Exposure ultrasound scan and history and examination
    Comparison venogram and arthrography of knee
    Outcome diagnosis of Baker's cyst and DVT