关节镜下治疗腘窝囊肿35例报道

目的:探讨关节镜技术治疗腘窝囊肿的方法及其临床疗效。方法:2002年10月至2004年7月,采用关节镜技术对35例腘窝囊肿患者进行治疗,其中男性14例,女性21例,年龄42～68岁,平均49.7岁。窝囊肿均为单侧,其中右膝16例,左膝19例。在处理关节内疾患的同时,在后内侧间室扩大窝囊肿与关节腔之间的通道口。4例巨大囊肿(直径>5cm)同时行后路关节镜下囊壁切除术。根据Rauschning和Lindgren分级方法评定手术效果。结果:本组35例腘窝囊肿患者在术中均可发现伴有关节内疾患,其中内侧半月板撕裂24例,外侧半月板撕裂7例,前交叉韧带撕裂4例,骨性关节炎27例,痛风性关节炎1例。术后未出现血管、神经或手术切口并发症。术后2～3天出院。随访时间6～29个月,平均11个月,94.2%的病例未出现囊肿复发。Rauschning和Lindgren分级结果:术前Ⅰ级4例,Ⅱ级12例,Ⅲ级19例;术后0级30例,Ⅰ级4例,Ⅱ级1例。结论:关节镜下治疗窝囊肿具有创伤小、恢复快、复发率低的优点。     

Popliteal cysts in adults. Prevalence, associated intraarticular lesions, and results after arthroscopic treatment.

The objective of this prospective study was to determine the prevalence of popliteal cysts and the associated intraarticular lesions in a group of 100 patients scheduled for arthroscopic surgery of the knee and to evaluate the results of arthroscopic treatment for these intraarticular lesions without removal of the cyst. One hundred patients without any knee complaints served as a control group. The diagnosis of a popliteal cyst was made on the basis of ultrasonography. The prevalence of popliteal cysts was 20% in the study group and 0% in the control group. Patients with a popliteal cyst had a significantly higher prevalence of medial meniscal tears (70% versus 19%) and of chondral lesions (85% versus 28%). Tears of the lateral meniscus, however, were more evenly distributed (20% versus 36%). Sixteen of 20 patients with a popliteal cyst were available for a follow-up examination 1 to 3 years after the arthroscopic procedure. Eleven popliteal cysts had persisted. Chondral lesions were the most relevant prognostic factor; all patients with persisting cysts had grade III or grade IV lesions. We conclude that the popliteal cyst is a secondary phenomenon and that treatment should address the underlying intraarticular lesions. In cases of osteoarthritis it may be impossible to treat the chondral lesion successfully in terms of eliminating the effusion.     

Double-contrast arthrography in secondary popliteal cysts

The diagnosis of a popliteal cyst is usually made on the basis of a history of discomfort and pain in the medial portion of the popliteal region, together with the finding of a palpable mass in the popliteal fossa. The clinical diagnosis can be confirmed by knee arthrography, if the cyst communicates with the knee joint; in recent years, however, noninvasive US has also become an important diagnostic aid to the radiologist. The S. Anna Hospital (Ferrara) experience is here reported in the diagnosis of symptomatic popliteal cysts, with no valve mechanism at the connection with the joint cavity. Arthrography was performed on 438 patients with popliteal cysts to determine their extent and size in relation to the symptoms and to the presence of underlying knee pathology; only 76 patients from this group were then submitted to surgery. The authors confirm that popliteal cyst is a frequent occasional finding during knee arthrography which almost completely lacks any clinical relevance in most cases. Moreover, taking arthrographic findings as a starting point, the authors describe the different anatomotopographic patterns of popliteal cysts.     

Percutaneous treatment of hepatic cysts by aspiration and sclerotherapy

We treated 35 patients who had hepatic cysts (30 congenital cysts, 5 hydatid cysts) with percutaneous puncture and sclerotherapy. After puncture and drainage of the cyst, a 95% alcohol solution was instilled as sclerosing agent into the cystic cavity. In all the patients, cyst puncture and drainage was successful. Follow-up in all cases was at least 12 months. In three uncooperative patients, cysts recurred due to incomplete sclerosis of the lining epithelium of the cyst wall. No major complications were encountered in all cases. All congenital cysts were treated on an outpatient basis. Patients with hydatid cyst were hospitalized for 48 h after puncture and aspiration. In our opinion, percutaneous drainage and sclerosis of congenital hepatic cysts can be considered an effective alternative to surgical treatment.     

Echinococcus granulosus cysts in the liver: management with percutaneous drainage

Twenty-one hepatic Echinococcus granulosus cysts (maximal diameter, 7.5 cm +/- 4.0) in 12 patients were aspirated and irrigated with hypertonic (20%) saline under sonographic guidance. All patients had signs and symptoms of a hepatic mass caused by the cysts, which had a prominent fluid component that appeared anechoic or hypoechoic, with marked enhancement of back wall echoes. The amounts of cyst fluid aspirated and of hypertonic saline used were 190 mL +/- 240 and 120 mL +/- 90, respectively. Separation of the endocyst from the pericyst and nonviability of scoleces were observed in all cysts. Mean hospital stay was 4.0 days +/- 3.4. Serial sonographic examinations revealed high-level echoes in the cyst cavity (heterogeneous echo pattern), which ultimately became uniformly echogenic (pseudotumor). After follow-up of 14.0 months +/- 5.5, maximal cyst diameter decreased to 4.1 cm +/- 3.1 (P less than .001). One patient died of unrelated causes; the remaining 11 patients experienced relief of symptoms and a decrease in liver span.     

The popliteal cyst

A popliteal cyst, originally called Baker’s cyst, is a synovial fluid-filled mass located in the popliteal fossa. The most common synovial popliteal cyst is considered to be a distension of the bursa located beneath the medial head of the gastrocnemius muscle. Usually, in an adult patient, an underlying intra-articular disorder is present. In children, the cyst can be isolated and the knee joint normal. The anatomy, etiopathogenesis, clinical presentation, differential diagnosis, imaging and treatment modalities of the popliteal cyst are presented. The authors try to answer some questions dealing with this condition. Is the cyst isolated, can it be treated as such, is its origin always well-defined and does surgical excision provide a permanent cure?     

Sonographic detection of Baker's cysts: comparison with MR imaging

OBJECTIVE: The objective of this study was to assess the ability of sonography to reveal Baker's cysts using MR imaging as a gold standard. MATERIALS AND METHODS: The study group consisted of 36 consecutive knees in 36 patients evaluated with both MR imaging and sonography. Inclusion criteria included axial proton density-weighted or T2-weighted MR images, a sonography report that documented the evaluation of the popliteal region of the knee, and sonographic and MR images that were available for review. The MR images were retrospectively reviewed for the presence of Baker's cyst (fluid signal between the semimembranosus and medial gastrocnemius tendons). Sonography reports were compared with the MR imaging results. The sonographic images were also retrospectively reviewed to determine whether any characteristic findings on sonography were significantly associated with the presence of Baker's cyst on MR imaging. RESULTS: Retrospective review of MR images revealed 21 Baker's cysts, one myxoid liposarcoma, one meniscal cyst, and 13 examinations with normal findings. The sonography reports revealed that the 21 Baker's cysts were correctly diagnosed, whereas the meniscal cyst and myxoid liposarcoma were misdiagnosed as Baker's cysts. Retrospective review of sonographic images showed a 100% sensitivity, specificity, positive predictive value, negative predictive value, and accuracy in the diagnosis of Baker's cyst when hypoechoic or anechoic fluid was present between the semimembranosus and medial gastrocnemius tendons. No other sonographic characteristics were significant. CONCLUSION: Identification of fluid between the semimembranosus and medial gastrocnemius tendons in communication with a posterior knee cyst indicates Baker's cyst with 100% accuracy.     

Diagnostic imaging for the study of popliteal masses in dialyzed patients

A new type of amyloidosis, secondary to the massive deposition of beta 2-microglobulin, has been identified which is peculiar to long-term (greater than or equal to 5 years) hemodialysis. Popliteal masses have recently been described as a possible manifestation of this type of amyloidosis. We report the results of a clinical-radiologic study of the popliteal region in 28 patients (14 males, 14 females; age 52.9 +/- 12.6 years) undergoing chronic hemodialysis for 60-212 months (mean 127 +/- 40). We aimed at determining the role of diagnostic imaging (conventional radiography, ultrasonography, Computed Tomography) in this pathologic condition. Clinics detected popliteal masses in 4 patients (bilateral in 1). US allowed 2 more cases to be detected and demonstrated the cystic nature of the lesion. Ultimately, popliteal masses could be demonstrated in 6 (bilateral in 5) of 28 patients (incidence 21.4%). In the 3 patients who were investigated by CT, cysts were seen to communicate with the joint cavity (Baker's cysts). In 1 case, immunocytochemical analysis showed diffuse beta 2-microglobulin positive amyloid deposition within the synovial wall of the surgically removed cyst. All the 6 patients experienced some of the major features of dialysis-related amyloidosis: carpal tunnel syndrome (6 cases), destructive arthropathy (5 cases), carpal and shoulder bone radiolucencies (5 and 4 cases, respectively). These findings, while documenting the high prevalence of popliteal cysts among long-term hemodialysis patients and the strong correlation with dialysis-related amyloidosis, stress the importance of diagnostic imaging in the detection and follow-up of such lesions.     

Hepatic cysts: treatment with alcohol

Six patients with hepatic cysts were successfully treated with percutaneous aspiration and temporary direct injection of sterile alcohol U.S.P. (95% ethanol) into the cyst cavities through an aspiration catheter. Five cysts were treated percutaneously using sonographic guidance, and one cyst was treated under direct vision during a cholecystectomy. It is ideal to treat with 25% replacement volume of alcohol. The larger cysts may require more than one alcohol treatment at the same sitting to be effective. There was no recurrence of the treated cysts on follow-up examinations of 6-18 months. Minor complications of transient pain, temperature elevation, and hemorrhage into a cyst occurred. No major complications were encountered. The results of this series would indicate that aspiration and injection of alcohol is the treatment of choice for symptomatic congenital hepatic cysts.     

Epidermoid cyst of the testicle: unusual magnetic resonance imaging findings

Epidermoid cyst of the testis is an uncommon benign tumor that can be treated by organ-preserving surgery when diagnosed preoperatively. Although some sonographic characteristics may be suggestive of epidermoid cysts, sonography is not completely diagnostic. Magnetic resonance imaging (MRI) findings may provide support for the diagnosis of epidermoid cysts. The MRI findings of testicular epidermoid cysts have been reported as either bull's eye or target in appearance, or with signal intensity characteristics more typical of a cystic lesion. In this paper, we present typical sonographic and unusual MRI findings of a testicular epidermoid cyst.     

Sonographically guided ethanol sclerotherapy for benign thyroid cysts: results in 22 patients

OBJECTIVE: We evaluate the efficacy and safety of sonographically guided ethanol sclerotherapy for benign thyroid cysts. SUBJECTS AND METHODS: We examined 22 patients with benign thyroid cysts (13 complex cysts and nine pure cysts) confirmed by fine-needle aspiration biopsy. Sonographically guided aspiration of the cystic fluid was followed by instillation of absolute ethanol (99.9%) into the cystic cavity: the injected volume of ethanol was 40-100% of the volume of fluid aspirated. The procedure was performed every 1 or 3 months for one or two sessions (mean, 1.2 sessions). Follow-up sonography was performed 1-10 months after the final session, and we observed patients after ethanol sclerotherapy for complications. RESULTS: The initial volume of the cysts ranged from 3.5 to 42 ml. In 21 patients, the volume of the cyst decreased or the cyst was obliterated. The volume of the cyst was reduced by 50-99% in 13 patients and by 1-49% in six patients, and the cyst was obliterated in two patients. In one patient, the volume of the cyst increased. The volume of ethanol instilled was significantly correlated with the volume reduction rate of the cyst. There was a difference in the volume reduction rate between patients in whom 10 ml or more of initial volume was used and those in whom less than 10 ml of initial volume was used; that is, the volume reduction rate of the group with the initial cyst volume of more than 10 ml was higher than that of the other group. Important long-standing and severe complications were not observed. CONCLUSION: Sonographically guided ethanol sclerotherapy is a safe and effective tool for the therapy of benign thyroid cysts.     

Neonatal ovarian cysts: sonographic-pathologic correlation

The authors reviewed the prenatal (11 infants) and postnatal (17 infants) sonograms and the clinical, surgical, and pathologic findings in 17 infants with an ovarian cyst to determine the sonographic features and natural history of neonatal ovarian cysts. An uncomplicated cyst (nontwisted, nonhemorrhagic) was completely anechoic and the cyst wall was imperceptible with sonography (five cases). A twisted or hemorrhagic cyst was cystic with a fluid-debris level, cystic with a retracting clot, septated with or without internal echoes, or solid (12 cases). These complicated cysts contained liquid and/or organized hematoma. Eleven of the 12 complicated cysts had a thin, highly echogenic wall. Cyst torsion commonly occurred in utero and could be diagnosed on prenatal sonograms by a typical sonographic appearance (eight cases). All of these infants were asymptomatic after birth. Four infants with hemorrhagic or twisted cysts were symptomatic. All cysts except one that resolved spontaneously were treated surgically, including three twisted cysts that showed no change in size over a 1-8-month interval. All of the cysts were of follicular origin.     

CSF flow measurement in syringomyelia

BACKGROUND AND PURPOSE: CSF circulation has been reported to represent a major factor in the pathophysiology of syringomyelia. Our purpose was to determine the CSF flow patterns in spinal cord cysts and in the subararachnoid space in patients with syringomyelia associated with Chiari I malformation and to evaluate the modifications of the flow resulting from surgery. METHODS: Eighteen patients with syringomyelia were examined with a 3D Fourier encoding velocity imaging technique. A prospectively gated 2D axial sequence with velocity encoding in the craniocaudal direction in the cervical region was set at a velocity of +/- 10 cm/s. Velocity measurements were performed in the larger portion of the cysts and, at the same cervical level, in the pericystic subarachnoid spaces. All patients underwent a surgical procedure involving dural opening followed by duroplasty. Pre- and postoperative velocity measurements of all patients were taken, with a mean follow-up of 10.2 months. We compared the velocity measurements with the morphology of the cysts and with the clinical data. Spinal subarachnoid spaces of 19 healthy subjects were also studied using the same technique. RESULTS: A pulsatile flow was observed in syrinx cavities and in the pericystic subarachnoid spaces (PCSS). Preoperative maximum systolic cyst velocities were higher than were diastolic velocities. A systolic velocity peak was well defined in all cases, first in the cyst and then in the PCSS. Higher systolic and diastolic cyst velocities are observed in large cysts and in patients with a poor clinical status. After surgery, a decrease in cyst volume (evaluated on the basis of the extension of the cyst and the compression of the PCSS) was observed in 13 patients. In the postoperative course, we noticed a decrease of systolic and diastolic cyst velocities and a parallel increase of systolic PCSS velocities. Diastolic cyst velocities correlated with the preoperative clinical status of the patients and, after surgery, in patients with a satisfactory foraminal enlargement evaluated on the basis of the visibility of the cisterna magna. CONCLUSION: CSF flow measurement constitutes a direct evaluation for the follow-up of patients with syringomyelic cysts. Diastolic and systolic cyst velocities can assist in the evaluation of the efficacy of surgery.     

Ovarian cysts in postmenopausal women: preliminary results with transvaginal alcohol sclerosis. Work in progress.

Seven patients with a recurrent ovarian cyst after transvaginal needle aspiration underwent alcohol sclerosis of the cyst. The cysts had the appearance of simple cysts at ultrasound (US). Sclerosis, an outpatient procedure, was performed with a transvaginal approach under continuous endovaginal US guidance. After aspiration of the cyst contents, approximately two-thirds of the aspirated fluid was replaced with 100% alcohol that was left in place for 20 minutes and then aspirated. No complication was observed. Four cysts had not recurred at follow-up examinations performed 2, 5, 7, and 12 months, respectively, after sclerosis. One patient underwent surgery because mucinous material was found on analysis of the specimen, which was proved to be a benign cystadenoma. The two other cysts recurred, and one patient underwent surgery. Alcohol sclerosis of ovarian cysts may have a role in the treatment of postmenopausal women with ovarian cysts with a low risk of malignancy.     

A therapeutic alternative in the treatment of epididymal cysts: percutaneous sclerotherapy

PURPOSE: Epididymal cysts are benign structures commonly seen during urological or ultrasound testicular examinations. They are treated only if symptomatic. Surgery is the standard treatment, although it carries a high risk of complications. We report our experience with sclerotherapy of epididymal cysts with sonographic assistance, and present an analysis of costs. MATERIALS AND METHODS: Between January 1999 and December 2000 we examined 48 epididymal cysts in 45 patients during ultrasound examinations. Except one, all of the patients were symptomatic. We decided to treat 25 symptomatic cysts that were more than 5 cm. in diameter. All of the patients refused surgery as they knew of the existence of the percutaneous method. The procedures were performed on a out-patient basis with ultrasound assistance and using 3% Polidocanol for sclerosis. Follow-up was at 3/6 and 12 months after treatment. If we found persistence of symptoms and/or a cyst was more than 5 cm of diameter, a second session was proposed. RESULTS: Twenty-five epididymal cysts were treated, with a technical success of 100%. Mean fluid evacuation was 36 ml; mean sclerosing agent injected was 4.5 ml. There were no complications. After 3/6 months 17/25 patients were free of symptoms (68%) and the cysts had disappeared in 15 of them (60%). After the repeat procedure, performed on only 4 patients, the number of symptom-free patients was 21/25 (84%). DISCUSSION: Epididymal cysts are often solitary cystic fluid collections that are occasionally reported during physical or ultrasound urological clinical examinations. They present as painless testicular enlargements on palpation and are echo-free at ultrasound examination. Percutaneous sclerotherapy has gained wide acceptance in the therapeutic handling of other pathologies and it appears as an ideal solution for this benign clinical condition of the superficial structures. Polidocanol, widely used on varicose vein therapies for its local anaesthetic properties, is the ideal sclerosing agent for superficial and delicate structures, such as epididymal cysts. The results of the present study have shown that symptomatic cysts may be cured in 84% of cases without complications and with low costs. CONCLUSIONS: Percutaneous sclerotherapy is a valid therapeutic alternative to surgery in the management of epididymal cysts: it is safe, effective, free of complications, less costly and shows good results in the follow-up.     

"Daughter cyst" sign: a sonographic finding of ovarian cyst in neonates, infants, and young children

OBJECTIVE: The purpose of this study was to assess the value of the "daughter cyst" sign, a sonographic finding of neonatal ovarian cysts, in differentiating ovarian cysts from other cystic masses in neonates, infants, and young children. SUBJECTS AND METHODS: In a prospective study, 23 neonates, infants, and young children (age range, 1 day to 36 months) with a lower abdominal cystic mass underwent sonography. We defined the daughter cyst sign as the presence of a small cyst along the wall of a cystic mass. The diagnosis of ovarian cyst was made when this sign was present. Detailed pathologic correlation was available in four ovarian cysts. The size, wall thickness, and contents of the cysts were also evaluated. RESULTS: The 23 cystic lesions included ovarian cyst (n = 11), lymphangioma (n = 3), enteric duplication cyst (n = 3), enteric cyst (n = 1), meconium pseudocyst (n = 2), hydrometrocolpos (n = 2), and urachal cyst (n = 1). The daughter cyst sign was seen in nine (82%) of 11 ovarian cysts but in none of the other cystic lesions. Sensitivity, specificity, and positive predictive value of the daughter cyst sign for differentiating ovarian cysts from other cystic lesions were 82%, 100%, and 100%, respectively. The daughter cyst corresponded to an ovarian follicle on pathologic examination. CONCLUSION: The daughter cyst sign is a specific sonographic finding for an ovarian cyst and may be useful in differentiating uncomplicated ovarian cysts from other cystic masses in neonates, infants, and young children.     

Efficacy of Single-Session Percutaneous Drainage and 50% Acetic Acid Sclerotherapy for Treatment of Simple Renal Cysts

Purpose To evaluate the efficacy and long-term results of single-session 50% acetic acid sclerotherapy for the treatment of simple renal cysts, and to compare the therapeutic results of 5 and 20 min sclerosant dwell techniques. Methods During the past 9 years, 50% acetic acid sclerotherapy was performed on 67 cysts in 66 patients. An acetic acid volume corresponding to a mean of 23% of the aspirated cyst volume was injected into the cysts. A 20 min dwell time with position changes was performed in 32 cysts (31 patients; group I) and 8% of volume for a 5 min dwell time in 35 cysts (35 patients; group II). Three- and 6-month sonographic or CT follow-up was performed for a minimum of 1 year. Complete regression was defined as no remaining cyst measurable on sonography with or without a scar at the renal cortex. Partial regression was defined as a decreased cyst volume compared with that before sclerotherapy. The Mann-Whitney U-test was used to compare the therapeutic results between the two groups. Results For 67 simple renal cysts, complete regression on follow-up was observed in 21 of 32 cysts (66%; group I) and 22 of 35 cysts (63%; group II); the remaining 24 cysts all showed partial regression. The partial reduction rate of the cyst’s volume was 97.4% (91.3–99.4%) in group I and 96.9% (90.8–99.5 %) in group II. There were no procedure-related major complications, and no statistically significant differences in the complete regression and partial volume reduction rates between the two groups (p > 0.05). Conclusion Fifty percent acetic acid is an effective and safe sclerosing agent for simple renal cysts. Fifty percent acetic acid sclerotherapy with a 5 min sclerosant dwell time, using a volume of about 10% of the aspirated volume, is sufficient for satisfactory results of simple renal cyst sclerotherapy.     

Simple renal cysts in children: diagnosis and follow-up with US

To assess the sonographic frequency of simple renal cysts in children, the authors retrospectively reviewed the results of abdominal sonographic studies of 16,102 children performed over a 5-year period between January 1, 1985, and December 31, 1989. Patients with abnormal renal function, dysplastic kidneys, or a family history of polycystic kidney disease were excluded from the study. The authors' review of the sonograms revealed 37 simple cysts in 35 patients (0.22%); the cysts were evenly distributed by age and sex and measured from 0.3 to 7.0 cm in maximum diameter. Sixteen cysts (43%) were in the upper pole of the right kidney. Follow-up sonographic studies of 23 cysts in 22 patients for up to 5 years showed no change in size in 17 cysts (74%). The largest cyst was drained percutaneously; all other cysts were managed conservatively. No patient showed deterioration of renal function. Therefore, the authors concluded that in a pediatric patient demonstrating normal renal function, no further intervention is necessary when a simple renal cyst is identified at sonography.     

Diagnosis and Percutaneous Treatment of Soft-Tissue Hydatid Cysts

The purpose of this study is to demonstrate and discuss the radiological features of four patients with muscular hydatid disease and to evaluate the results of percutaneous treatment in these patients. Four patients (three female and one male) with six muscular hydatid cysts underwent percutaneous treatment and were followed up. The mean age of patients was 35 years (range: 12–60 years). Type I (n = 2), type II (n = 1), and type III (n = 3) hydatid cysts were observed in the thigh (n = 3) and gluteal (n = 1) region on radiologic examination. All interventions were performed under sonographic and fluoroscopic guidance. According to the type of the cyst, the procedure was carried out by either a “catheterization technique with hypertonic saline and alcohol” or a “modified catheterization technique.” The mean cathaterization time was 13.7 days, ranging from 1 to 54 days. The dimensions of the residual cavity were noted at every sonographic control, and an average of 96.1% volume reduction was obtained in six cysts of four patients. No sign of viability was observed during the follow-up period. Cavity infection and cellulitis were observed as complications, which resolved after medical therapy. Percutaneous treatment is a safe and effective procedure in patients with soft-tissue hydatid cysts and should be considered as a serious alternative to surgery.     

Percutaneous therapy of hydatid cyst of the liver with ultrasound-guided double puncture-aspiration and alcoholization]

Fourteen patients (9 females, 5 males; age range: 22-80 years) with 16 univesiculated hydatid cysts of the liver (O ranging 4.2-14 cm) underwent two sessions of puncture-aspiration-alcohol injection (D-PAI) under real-time US guidance at 3-day intervals. Two patients had postoperative recurrences. One patient was pregnant (9 weeks' gestation): her cyst doubled its volume over 2 months. One patient had HBV chronic hepatitis treated by means of interferon: also in this case the cyst doubled its volume. The remaining were high-risk patients for surgery or had refused operation. At US follow-up (ranging 4-24 months) 6 cysts exhibited complete reconstitution of liver parenchyma. In the extant patients two different US patterns were observed: 1) liquid areas with detached inner membranes (4 cysts); 2) solid inhomogeneous areas (6 cysts). In these cases the volume was reduced by 50-80%. No allergic complication occurred either during or after the procedure. Two patients only were affected with vomiting and fever, which resolved in a few hours. Our results indicate D-PAI of univesiculated hydatid cysts of the liver to be an effective alternative to surgery.