Diagnosis of politeal cyst is usually evident on clinical examination. Conventional radiography in the anteroposterior, lateral, and oblique projections is done to check fluid density and to rule any other lesion that might give rise to poplliteal swelling.
Ultrasonography helps in assessing th swelling and can distinguish between fluid and solid mass.Popliteal cysts are best shown by sagittal ultrasound image projection. Ultrsound can also be used o rule vascular tumours by looking at arterial pulsations.
Computed tomography and MRI will show the lesion in better way and can reveal its relationship to adjacent soft tissues and knee joint.
Arthrography is rarely indicated
Lipoma, aneurysm, thrombophlebitis, neuroma, nerve ganglia, semimembranosus hypertrophy, and enlarged lymph nodes are other conditions to consider in the differential diagnosis.
Fibrosarcoma, synovial sarcoma, and fibrous histiocytom, pigmented villonodular synovitis , rheumatoid arthritis, tuberculosis, brucellosis, or a pyogenic abscess may as well cause a cystic swelling in the Popliteal area.
Popliteal cyst usually arises in the medial part of the fossa. If the involvemnet is lateral, it could be something else.
Treatment
In shildren, the cyst might disappear on its own. So a wait and watch policy should be adopted.
Cysts which are not symptomatic should not be subjectee to surgery. Surgery should be done if the cyst does not regress after 2-3 years of observation.
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