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A 10-year-old boy presents with a mobile, soft, and painless mass over the posteromedial aspect of his knee. MRI demonstrates a simple cyst. What is the most appropriate next step in treatment?
CT with intravenous contrast
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The description of the mass (soft and non-tender, in the posterior knee) in a young patient suggests that this is a popliteal, or Baker’s, cyst. The article by Dinham reviewed the natural history of 120 cases of popliteal cysts in children and reported that, of seventy untreated cysts, fifty-one disappeared spontaneously during a mean period of one year and eight months. The article also noted that those cysts which fail to regress spontaneously may respond to aspiration, but have a high recurrence rate. Given the lack of symptoms and the likelihood of resolution, observation is the first-line treatment for most popliteal cysts.
J Bone Joint Surg Br. 1975 Feb;57(1):69-71. PMID: 1117024 (Link to Abstract)
Dinham, BJJ 1975
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