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

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

Histology

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 (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:

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. 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
Edit Article Share Article

Article Information

rID: 18707
System: Musculoskeletal
Synonyms or Alternate Spellings:
  • Ganglion cysts
  • Ganglion cyst - MSK
  • Ganglion cyst general
  • Ganglion cyst - musculoskeletal
  • Drag
    Case 1: wrist
    Drag here to reorder.
  • Drag
    Case 2: intra articular ganglion cyst of knee
    Drag here to reorder.
  • Drag
    Case 3: in association with vastus lateralis
    Drag here to reorder.
  • Drag
    Case 4: in sinus tarsi
    Drag here to reorder.
  • Drag
    T2* GRE
    Case 5: in FCR tendon sheath
    Drag here to reorder.
  • Drag
    Case 6: in spinoglenoid notch
    Drag here to reorder.
  • Drag
    Ganglion cyst
    Case 7: in dorsum of wrist
    Drag here to reorder.
  • Drag
    Dorsal wrist gang...
    Case 8: in dorsum of wrist
    Drag here to reorder.
  • Drag
    Case 9: close to tarsal tunnel
    Drag here to reorder.
  • Drag
    Case 10: cyst recurrence on lateral aspect of knee
    Drag here to reorder.
  • Drag
    Case 11: spinoglenoid notch ganglion cyst
    Drag here to reorder.
  • Drag
    Case 12: peri A1 pulley ganglion
    Drag here to reorder.
  • Drag
    Case 13
    Drag here to reorder.
  • Drag
    Case 14: spinoglenoid notch ganglion cyst
    Drag here to reorder.
  • Drag
    coronal stir of r...
    Case 15: spinoglenoid notch ganglion cyst
    Drag here to reorder.
  • Drag
    Case 16: post traumatic
    Drag here to reorder.
  • Drag
    Case 17 : Pisotriquetral joint cyst
    Drag here to reorder.
  • Updating… Please wait.
    Loadinganimation

    Alert_accept

    Error Unable to process the form. Check for errors and try again.

    Alert_accept Thank you for updating your details.