Diving Pes Anserine Bursal Rupture in a Patient with Knee Osteoarthritis: Case Report
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IMAGING
Diving Pes Anserine Bursal Rupture in a Patient with Knee Osteoarthritis: Case Report Mohammad Fouad Abdel-Baki Allam 1
&
Sherif Ahmed El-Refai 2 & Ahmad Fouad Abdel-Baki Allam 3
Accepted: 26 April 2020 / Published online: 9 May 2020 # Springer Nature Switzerland AG 2020
Abstract Pes anserine bursitis is not an uncommon pathology especially in the context of knee osteoarthritis; however, ruptured pes anserine bursitis is a rare event. Herein, the authors present a case of diving pes anserine bursal rupture in a patient with knee osteoarthritis who developed postero-medial knee tender swelling. In our case, the bursal rupture was contained, and dived posteriorly, resulting in a cystic calf swelling; the original bursa itself was collapsed beneath the pes anserine tendon, giving a taillike appearance, such tail-like appearance could help in accurate localization of swelling origin and make the diagnosis of bursal rupture much easier. The tail-like appearance deep to the pes anserine tendon was found to be a helpful imaging feature when assessing cystic calf swelling; it should be kept in mind when pes anserine bursal rupture is a differential diagnostic consideration, as it could indicate the origin of resultant swelling. Keywords Pes anserine bursitis . Diving pes anserine bursal rupture . Knee osteoarthritis . Cystic calf swelling
Background Pes anserine bursa lies deep to the pes anserine tendon which is a conjoined insertion of the gracilis, sartorius and semitendinosus tendons, at the upper medial tibia [1]. Pes anserine bursa can be inflamed in the context of overuse or arthritis-related micro-instability of the knee. Inflammation of the pes anserine bursa presents clinically with medial knee pain that can mimic medial meniscal tear [2, 3]. Pes anserine bursitis can occur in as high as 20% of patients with knee osteoarthritis especially in high grades; it is uncommon if compared with the incidence of other periarticular cysts This article is part of the Topical Collection on Imaging * Mohammad Fouad Abdel-Baki Allam [email protected] Sherif Ahmed El-Refai [email protected] 1
Diagnostic radiology, Faculty of Medicine, Minia University, Minia, Egypt
2
Diagnostic radiology, Faculty of Medicine, Benha University, Qalyubia, Egypt
3
Orthopedic surgery and traumatology, Faculty of Medicine, Minia University, Minia, Egypt
such as Baker’s cyst or if compared with knee effusion; however, ruptured pes anserine bursitis is a much more rare event, and its exact incidence is unknown [3, 4]. Herein, the authors present a case of ruptured pes anserine bursitis which was detected using MRI, in a patient with knee osteoarthritis who developed a tender swelling at the posteromedial knee.
Case Presentation A 57-year-old female with a known history of right knee osteoarthritis felt a sudden pain at the posterior aspect of the right knee while standing up from sitting position. She presented to our hospital with tender swelling at the uppermost medial calf. Clinically, a ruptured Baker’s cyst, deep vein thrombo
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