Presentation
The patient presented with swelling and pain in the lateral aspect of the proximal left leg for three days.
Patient Data
MRI of the left leg shows a juxta-articular multilocular cystic lesion in the proximal part of the lateral compartment of the leg anterior to the proximal part of the fibula between the extensor digitorum longus and peroneus longus muscles. It has a tunnel-like connection to the proximal tibiofibular joint.
Rim enhancement is seen after contrast injection. No solid enhancing part is identified.
Additionally, a small defect is seen in the lower pole of the cystic lesion, with associated oedema and effusion of the subcutaneous tissue in the outer aspect of the leg as shown on axial and coronal fat saturation images indicating rupture.
Case Discussion
Ganglion cysts, typically found near joints and tendons, rarely occur in the proximal tibiofibular joint. Patients with these cysts typically present with progressive swelling in the anterolateral leg, accompanied by pain and neurological symptoms due to peroneal nerve compression. Rupture of the cyst can be a complication, leading to sudden-onset pain, as seen in our patient. Diagnosis relies on imaging, with MRI serving as the gold standard. MRI effectively characterises the lesion, clearly revealing, as in our case, the connection between the cyst and the proximal tibiofibular joint space.
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