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.
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.
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.
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:
There are many ways of classifying ganglion cysts.
In relation to structure, e.g. bone
- within bone: intraosseous ganglion cyst
- adjacent to bone: periosteal ganglion cyst - rare and may occur more frequently in males 4
- away from bone: soft tissue ganglion cyst
In relation to structure, e.g. joint
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.
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’’.
General imaging differential considerations include:
- synovial cyst: these have a synovial lining, and although histologically distinct from ganglia, are indistinguishable on imaging 1.
- ultrasound (introduction)
- ultrasound physics
- basic physics
- pulse-echo imaging
- real-time imaging
- contrast-enhanced ultrasound
- Doppler imaging
- ultrasound artifacts
biological effects of ultrasound
- mechanical index
- thermal index
- history of ultrasound
- obstetric ultrasound
- gynaecologic ultrasound
- endometrial thickness
- bicornuate uterus
- scrotal/testicular ultrasound
- vascular ultrasound
- mesenteric vessels
- breast ultrasound
- shoulder ultrasound
- elbow ultrasound
- wrist ultrasound
- hand ultrasound
- hip ultrasound
- knee ultrasound
- ankle/foot ultrasound
- paediatric musculoskeletal ultrasound
- skin/soft tissue ultrasound
- ultrasound of arthropathies
- liver ultrasound
- gallbladder ultrasound
- pancreas ultrasound
- gastrointestinal ultrasound
- renal ultrasound
- renal transplant ultrasound
- neck and thyroid ultrasound
- pediatric ultrasound
- transcranial ultrasound
- ultrasound interventions
- ultrasound guided biopsy
- ultrasound guided percutaneous drainage
- ultrasound guided musculoskeletal interventions
- 1. Teh J, Whiteley G. MRI of soft tissue masses of the hand and wrist. Br J Radiol. 2007;80 (949): 47-63. doi:10.1259/bjr/53596176 - Pubmed citation
- 2. Meyers SP. MRI of Bone and Soft Tissue Tumors and Tumorlike Lesions, Differential Diagnosis and Atlas. Thieme Medical Pub. (2008) ISBN:158890251X. Read it at Google Books - Find it at Amazon
- 3. Wang G, Jacobson JA, Feng FY et-al. Sonography of wrist ganglion cysts: variable and noncystic appearances. J Ultrasound Med. 2007;26 (10): 1323-8. J Ultrasound Med (citation) - Pubmed citation
- 4. Beaman FD, Peterson JJ. MR imaging of cysts, ganglia, and bursae about the knee. Radiol. Clin. North Am. 2007;45 (6): 969-82, vi. doi:10.1016/j.rcl.2007.08.005 - Pubmed citation
- 5. Teefey SA, Dahiya N, Middleton WD et-al. Ganglia of the hand and wrist: a sonographic analysis. AJR Am J Roentgenol. 2008;191 (3): 716-20. doi:10.2214/AJR.07.3438 - Pubmed citation
- 6. Kim SK, Park JM, Choi JE et-al. Intratendinous ganglion cyst of the semimembranosus tendon. Br J Radiol. 2010;83 (988): e79-82. doi:10.1259/bjr/23178227 - Pubmed citation
- 7. Thornburg LE. Ganglions of the hand and wrist. J Am Acad Orthop Surg. 1999;7 (4): 231-8. Pubmed citation
Synonyms & Alternative Spellings
|Synonyms or Alternative Spelling||Include in Listings?|
|Ganglion cyst - MSK||✗|
|Ganglion cyst general||✗|
|Ganglion cyst - musculoskeletal||✗|