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.


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 adjacent structures, and these are best discussed under location specific subsites. A proportion of patients have a history of trauma.


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. Typically, they are attached to the underlying joint capsule or tendon sheath 8.


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.


They can occur within muscles, menisci and tendons (intratendinous 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:


There are many ways of classifying ganglion cysts.

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

Radiographic features


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.


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. Periosteal bone formation may be visible.

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

Ruptured cysts 9

Ruptured cysts are often irregularly delineated and show pericapsular oedema on T2 weighted imaged. The cyst itself may show diffuse enhancement after intravenous administration of gadolinium contrast, but there is often an absence of enhancement of the pericapsular soft tissue oedema.

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

Ultrasound - general index

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