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Baker Cyst DVT Mimic — SCE Rheumatology MCQ

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EasyRheumatoid ArthritisBaker Cyst DVT MimicSCE Rheumatology

A 45-year-old woman with rheumatoid arthritis and active knee synovitis develops sudden unilateral calf pain and swelling. A ruptured Baker cyst is suspected, but deep vein thrombosis must be excluded. Which investigation most directly distinguishes these conditions at the initial imaging assessment?

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Correct answer: E — Duplex venous and targeted popliteal/calf ultrasonography

Duplex venous ultrasonography combined with targeted assessment of the popliteal fossa and calf is the best initial imaging strategy. Venous compression and flow assessment identifies or excludes DVT, while musculoskeletal ultrasonography can demonstrate a Baker cyst and fluid tracking into the calf after rupture. The two conditions cannot be distinguished reliably by clinical examination, and DVT can occasionally coexist with a Baker cyst. D-dimer alone neither confirms cyst rupture nor localises thrombosis. Contrast venography is invasive and is not routine first-line practice. MRI can define cyst anatomy and fluid dissection but is generally reserved for inconclusive ultrasonography or diagnostic uncertainty rather than used before venous ultrasound.

Reference: Zmerly H, et al. Ruptured Baker's Cyst Demystified: Current Evidence, Diagnostic Strategies, and Treatment Options for an Under-Recognized Condition. Cureus. 2026;18(1):e101686. https://pubmed.ncbi.nlm.nih.gov/41552735/