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Baker's cyst is a closed collection of fluid that forms in the posterior aspect of the knee. Usually, it appears as a non-painful inflammation in the popliteal fossa. In adults, its aetiology is secondary to problems that cause distension of the knee joint; It is often associated with rheumatoid arthritis and osteoarthritis. Occasionally, the cyst may become oversized and rupture with the consequent leakage of synovial fluid into adjacent tissues, presenting a clinical course similar to acute thrombophlebitis. Infection of a popliteal cyst is an uncommon complication and is associated with septic arthritis. In this paper, we present the case of a patient, an intravenous drug user (IVDU), who developed a spontaneous infection of a Baker's cyst secondary to Staphylococcus aureus, which was diagnosed in the emergency department (ED) using point-of-care-ultrasound (POCUS). Case Report APR 2019 vol. 04 iss. 01 | POCUS J | 7 Figure 1. Within the posterior aspect of the left calf on the medial aspect there is an extremely large cystic lesion measuring 18.7 cm in length and 4 cm in width with no adverse features. The cystic lesion is communicating with the semimembranosus/medial head gastrocnemius bursa more proximally in the knee where it demonstrates internal echoes and synovial thickening and a single septation. niques, CT and magnetic resonance imaging (MRI) allow the cyst to be clearly defined, as well as to confirm rupture of the cyst along with any haemorrhagic complications, and whether it is accompanied by polymyositis or osteomyelitis. However, ultrasound can also easily detect a cystic structure in the popliteal fossa. Classically it can be identified as a well-defined cyst with a 'neck' at its deepest extent, extending into the joint space between the semimembranosus tendon and the medial head of the gastrocnemius. Identification of a fluid-filled structure at the posteromedial knee is suggestive of a popliteal cyst, but identification of the 'neck' between the tendons is necessary for a definitive diagnosis, the ‘neck’ has been described as being shaped like a "speech bubble" or "talk bubble" [6]. In cases of bacterial infection, the drainage of the capsule or cyst fluid usually shows the presence of purulent fluid. When Gram staining or bacterial culture of the aspirate is negative, investigation of a fungal or mycobacterial aetiology should be ruled out. Overall, the most frequently isolated infectious etiologic agent is Staphylococcus aureus, although it can be easily infected by other systemic infectious agents. Other detected organisms include; mycobacterium tuberculosis, candida albicans and streptococ-

Infected Baker’s cyst, diagnosed in the emergency department using POCUS