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An 81-year-old man presented to the emergency department with left calf painful swelling for 4 days. He has a history of hypertension and ischemic heart disease. He denied any injury. Physical examination was remarkable for left calf tender swelling, and ecchymosis around left ankle (Fig. 1). Compression ultrasonography excluded deep vein thrombosis.
What is the diagnosis?
Ultrasound of left knee confirmed a ruptured popliteal cyst.
A common mimicker of deep vein thrombosis is a ruptured popliteal cyst. Popliteal cysts are synovial outpouchings of the knee joint, usually due to arthritis. If ruptured, bleeding would dissect down the calf muscles and reach the ankle in a few days, causing a characteristic crescent-shaped ecchymosis beneath the malleolus [