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Ganglion cyst

Ganglion cysts are non-malignant cystic masses that occur in association with musculoskeletal structures 6. They are sometimes also simply referred to as ganglia or a ganglion, but should not be confused with the anatomical term ganglion.

Epidemiology

They occur more commonly in young women (especially in and around the hand) 7

Clinical presentation 

They can cause a myriad of symptoms dependant on location due to mass effect on adjacen structures, and these are best discussed under location specific sub sites.

Pathology

The aetiology of ganglion cysts is unclear. They may represent sequelae of synovial herniations or coalescence of small degenerative cysts arising from the tendon sheath, joint capsule or bursae. A proportion of patients have a history of trauma. 

Histologically, ganglia have a thin connective tissue capsule, but no true synovial lining, and contain mucinous material filled with gelatinous fluid rich in hyaluronic acid and other mucopolysaccharides 4

Location

They can occur within muscles, menisci and tendons (intratendidinous ganglion cysts 6).

According to anatomy

They can occur in numerous locations but most commonly (70-80% of cases) occur in relation to the hand or wrist (ganglion cysts of the hand and wrist) in this location, notable specific sub sites include 1:

  • dorsum of wrist: ~60% of all hand ganglion cysts
  • volar aspect of  wrist: ~20%
  • flexor tendon sheath: ~10% 
  • in association with the distal interphalangeal joint: ~10%

Other notable locations include:

Classification

There are many ways of classifying ganglion cysts.

In relation to structure, e.g. bone
In relation to structure, e.g. joint

Radiographic features

Ultrasound

The vast majority are anechoic to hypoechoic on ultrasound and have well defined margins 3,5. Many demonstrate internal septations as well as acoustic enhancement 5.

MRI

Usually seen as a unilocular or multilocular rounded or lobular fluid signal mass, adjacent to a joint or tendon sheath. Very small cysts may simulate a small effusion, but a clue to the diagnosis is the paucity of fluid in the remainder of the joint and the focal nature of the fluid. 

Signal characteristics include:

  • T1: typically ganglia are low signal although high proteinaceous content or haemorrhage may result in lesions appearing isointense or hyperintense on T1 weighted images.
  • T2/STIR: typically high signal 

History and etymology

Ganglion cysts are thought to be first described by Hippocrates as ‘‘knots of tissue containing mucoid flesh’’. 

Differential diagnosis

General imaging differential considerations include:

  • synovial cyst: these have a synovial lining, and although histologically distinct from ganglia, are indistinguishable on imaging 1.

Related articles

Ultrasound

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