- 期刊
貝克氏囊腫破裂表現類似深層靜脈栓塞於類風濕性關節炎患者：病例報告
A Ruptured Baker's Cyst Mimicking Deep Vein Thrombosis in a Patient with Rheumatoid Arthritis: A Case Report
摘要
貝克氏囊腫（Baker's cyst）是因腓腸肌內側頭部與半膜肌肌腱間的滑液囊腫脹而形成，常和膝關節的病變有關，如退化性關節炎、類風濕性關節炎及其他發炎性關節病變等疾病。此病症會造成膝後側腫脹與疼痛，關節液抽吸與類固醇注射可緩解症狀，但更重要的是需治療潛在疾病，才可預防復發。貝克氏囊腫可能會造成破裂（ruptured Baker's cyst）的併發症，導致小腿腫痛，由於和深層靜脈栓塞的症狀類似而不易診斷，若因此而給予抗凝血劑的治療，可能會因此造成出血而使病情更加惡化，發現早期可用骨骼肌肉超音波影像檢查來協助鑑別診斷。本病例為67歲女性，是一類風濕性關節炎的病患，最初抱怨左膝後側疼痛，之後出現疑似深層靜脈栓塞的小腿腫脹、疼痛症狀，但經電腦斷層血管攝影及骨骼肌肉超音波檢查後確診為貝克氏囊腫破裂，並在接受復健與藥物治療後痊癒。
並列摘要
Baker's cysts arise from a distension of a gastrocnemio-semimembranosus bursa, which are often associated with knee pathology including osteoarthritis, rheumatoid arthritis, and other inflammatory arthropathies. Clinical presentations of Baker's cysts are posterior knee swelling, tightness, and pain. Knee joint aspiration and intra-articular corticosteroid injection can relieve symptoms. However, treating underlying diseases is more important for recurrence prevention. Cyst rupture is a complication of Baker's cysts and may induce leg swelling and pain mimicking deep vein thrombosis. It is difficult to distinguish between a ruptured Baker's cyst and deep vein thrombosis because of similar symptoms. If a ruptured Baker's cyst is misdiagnosed as deep vein thrombosis and patients are treated with anticoagulants, this may result in cyst hemorrhage, which deteriorates the patient's condition. Musculoskeletal ultrasound can help early detection and differentiation between these two disorders.We report the case of a 67-year-old woman with a history of rheumatoid arthritis who complained initially of left posterior knee pain. Subsequently, left leg swelling and pain were noted, and deep vein thrombosis was first suspected. However, a ruptured Baker's cyst was diagnosed after performing computed-tomographic angiography and musculoskeletal ultrasonography. The patient recovered after treatment with rehabilitation and medication.
延伸閱讀
- Lin, Y. M., Ko, E. C. C., Chen, Y. K., Chen, C. Y., & Chen, C. H. (2016). 與囊腫病變相似之口內血管內皮瘤－病例報告. 臺灣口腔顎面外科學會雜誌, 27(3), 211-222. https://www.airitilibrary.com/Article/Detail?DocID=a0000494-201609-201610270008-201610270008-211-222
- Chen, Y. H., Chen, H. C., Chou, Y. C., Chu, S. J., Kao, S. Y., Liu, F. C., Lu, C. C., & Chang, C. C. (2018). 貝克囊腫之臨床表現及其病因之探討. Formosan Journal of Rheumatology, 32(1), 18-24. https://doi.org/10.6313/FJR.201809_32(1).0003
- Yang, D. H., Chang, W. C., Hou, T. Y., Yeh, S. F., Chang, D. M., Kuo, S. Y., & Chen, C. H. (2009). 貝克氏囊腫合併細菌感染在一新診斷全身性紅斑性狼瘡的病人. Journal of Medical Sciences, 29(3), 151-154. https://doi.org/10.6136/JMS.2009.29(3).151
- Wong, W. K., Su, W. K., & Yuan, P. J. (2020). Deep Vein Thrombosis in the Upper Extremities Associated with Protein C Deficiency: A Case Report. Acta Cardiologica Sinica, 36(5), 520-522. https://doi.org/10.6515/ACS.202009_36(5).20200703A
- Wong, W. K., Li, J. Y., & Wang, P. C. (2006). Abdominal Pain Resulting from Acute Thrombosis of a Superior Mesenteric Artery Mycotic Aneurysm-A Case Report. Acta Cardiologica Sinica, 22(2), 107-111. https://www.airitilibrary.com/Article/Detail?DocID=10116842-200606-22-2-107-111-a