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Ganglion cyst

Ganglion cysts are non-malignant tumour-like cystic lesions 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.


As a crude over generalisation, they can be considered to most commonly occur in young women (especially in and around the hand). 

Clinical presentation 

They can cause a myriad of symptoms dependant on location and these are best discussed under location specific sub sites.


Their aetiology 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


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 include1:

  • 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 hypo-echoic on ultrasound and well defined 3,5. Many may demonstrated presence of locules as well as acoustic enhancement 5.


Usually seen as a unilocular or multilocular rounded or lobular fluid signal mass is seen 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 characeristics include

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


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, are histologically distinct from ganglia but are indistinguishable on imaging 1

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