Presentation
Painful palpable dorsal wrist mass, rule out vascular lesion
Patient Data
Tented lobulated, well-circumscribed cystic lesion seen at the dorsal aspect of the left radiocarpal junction. It is situated within the deep subcutaneous fat region, overlying the fascia of sheath of extensor retinaculum, and forming subtle "comet tail" and" "claw sign" with the sheath of the extensor digitorum tendons.
There is associated mild tenosynovitis of the third extensor compartment just at this level.
Post gadolinium, there is thin enhancement at the periphery, but not within, which may signify mild inflammation. There is no associated solid or nodular component. The structure is seen overlying one of the small branches off the radial artery dorsally, but there is no associated ectatic feeding or draining in relation to this lesion.
There are T2 hypointense foci within the lesion, nonspecific, and could represent tiny calcifications.
Case Discussion
Cystic lesion at the dorsal aspect of the left wrist, the characteristics of which are suggestive of an inflamed dorsal ganglion cyst of tendon sheath origin, from the fourth extensor compartment.
Appearance is not compatible with a conventional ganglion cyst of articular synovial origin. A vascular malformation is deemed unlikely given absence of identifiable feeding or draining vessels, and the tendon sheath origin.