Presentation
Painful left wrist with soft tissue bulge on the dorsal aspect of the wrist.
Patient Data
There is a well-defined thin wall multilocular cystic mass-like lesion on the dorsal aspect of the middle to the distal part of the wrist at the level of luno-capitate joint and related structures encased the adjacent extensor tendons and with a deeply extended small pedicle. The cyst has intermediate intensity on T1 weighted and high intensity on PD-FS and STIR MR images.
Case Discussion
A ganglion cyst is the most common soft tissue mass of the wrist and hand and the dorsal wrist is the most common location of the cyst and usually has a pedicle communicating with a joint more commonly scapholunate joint and more occurs in women during second to fourth decades of life and can be also seen in children. The exact mechanism of cyst formation is not known but the coalescence of extraarticular mucin droplets is the most accepted theory at the moment. Fluid within the ganglion cysts is gelatinous and they have no synovial cells within the wall and as a result, are not true cysts. These cysts are usually related to tendons and ligaments but in the minority of cases are intraosseous.
An ultrasound exam is a first-line imaging modality but magnetic resonance imaging is a helpful imaging modality for differentiating ganglion cysts and chronic synovitis and can depict the deep extension and intraarticular extension of the cyst and its pedicle and is also useful for preoperative planning.
The gold standard treatment for ganglion cysts is complete surgical excision of the cyst and resection of the related joint capsule, but the ultrasound-guided aspiration of the cyst is an effective method for reducing patients' pain and discomfort.