0:01

The seventh case.

0:02

It's a amazing case again.

0:06

So, because I like amazing,

0:08

and I, I learned, I learned to like this, this word amazing

0:13

because of Dr.

0:14

Rasnick, because he's, uh, he says amazing a lot of times.

0:18

And so I internalized it. So let's go to the seventh case.

0:23

The seventh case is a 22-year-old male

0:26

with posterior light pain and weakness to planter flexion

0:30

and inversion of the foot.

0:32

So that's the history of the patient.

0:33

So let's see the images.

0:36

And in this this case, it's, uh, it's incredible for,

0:40

uh, some reasons.

0:42

And one of the reasons that I, I'd like to show you here

0:46

is this one.

0:48

So we can see this image right here.

0:51

This is to two, uh, weighted images with fat saturation.

0:54

We can see cyst coming out,

0:57

coming off the proximal tibial fibular joint,

1:02

and it's going posterior most of the time.

1:05

The cyst, uh, lesions

1:08

or the synovial cysts of the, uh,

1:12

tibial fibular proximal tibular joint, it, uh,

1:14

they go anteriorly.

1:16

They go to this area. Here they go.

1:18

They stay together with the lateral compartment of the,

1:23

uh, of the leg.

1:25

They stay close to the, to the common peroneal, uh,

1:30

nerve or the branches of the common peroneal nerve.

1:34

They don't go posteriorly, don't, they don't go behind.

1:37

But in this case, uh, the cyst were went behind

1:42

and it went to this region.

1:44

Right here, we can see the vessels,

1:46

but here we can see the tibial nerve.

1:49

So the tibial nerve is compressed by this cyst right here.

1:55

And we can see that the innervation of the muscles

2:00

of the deep posterior compartment,

2:03

and also by a part of the superficial, uh,

2:06

posterior compartment right here,

2:08

that are the muscles innovat by the tibial nerve.

2:13

So that's a beautiful case showing these findings.

2:16

But, uh, how I'm sure that this, uh, it's a cyst

2:19

because we can see also the T one image right

2:22

here, the T one image.

2:24

Uh, the image has a low signal intensity, uh, uh, the image,

2:29

uh, it's a low signal intensity imaging.

2:31

And here, post contrast, we can see just, uh, uh,

2:36

uh, a peripheral enhancement of the lesion.

2:40

So it's not a solid, uh, lesion. It's not a tumor.

2:44

Um, just to show you here,

2:47

two important findings of this case.

2:49

Let's, uh, come with me and let's see the axial images.

2:54

Here we can see the edema of the muscles, especially the,

2:59

The deep posterior compartment.

3:01

And on T two with fat sets, uh, with fat set.

3:04

And in T one without fat set, we can't see.

3:09

There isn't any sign of fatty infiltration.

3:13

So this is an acute lesion. Okay?

3:16

So this is good for the patient.

3:17

It's good for to, to the, to the doctor to treat this kind

3:20

of lesion because, uh, the muscles

3:23

or the musculature of the patient is good.

3:26

There is no fat saturate, uh, there's no fat replacement.

3:30

So the prognosis, it's, uh, it's very good

3:34

for this patient right here.

3:37

And we have some images of the knee,

3:40

but the image of the knee, uh, they,

3:43

they are showing the same thing are showing the,

3:45

the image show.

3:47

They show the, the, the, the synovial cysts,

3:51

synovus coming out from the proximal tobo

3:54

fibrillar, uh, joint.

3:56

Most of the time this ist they go anteriorly,

3:59

they travel sometimes through

4:02

or inside the recurrent articular nerve

4:06

that is one branch of the, of, of the coop perennial nerve.

4:11

And they compress the coop perennial nerve.

4:13

It's well described on the literature,

4:16

but in my experience, uh, posterior cysts,

4:19

it, uh, they are rare.

4:21

And this is one of these cases. Okay?