Ganglion Cyst

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Detailed Analysis

A1 - The pink arrows (images 1 and 2; 6 and 7) demonstrate a tail extending back to the joint capsule and subsheath portion of the extensor carpi ulnaris.
A2 - (a) ganglion pseudocyst, (b) epidermoid, (c) myxoma, (d) capsular cyst, (e) pisotriquetral bursal cyst, or (f) capsulosynovial cyst associated with inflammatory arthritis (such as rheumatoid).
A3 - (a) ganglion with a tail to either the capsule or sheath of a tendon, (b) neural tumor with a tail to a nerve, (c) aneurysm or pseudoaneurysm with a tail to a vessel, or (d) capsular or synovial cyst with a tail to a joint.
A4 - The most common is along the dorsal scapholunate interval near the dorsal limb of the scapholunate ligament (SL) and the radial limb of the intercarpal ligament. Sometimes these project at the junction of the scaphoid and base of the capitate dorsally. The second most common location is along the palmar aspect of the wrist near the volar SL ligament and capsule near the base of the radioscaphocapitate extrinsic or the base of the radial lunatotriquetral ligament extrinsic. In other words, a ganglion in this location is extremely atypical. Its intimacy with the extensor carpi ulnaris is problematic as it relates to dynamic motion (i.e. can restrict).

Patient Cases

• 63YOF with these ganglions bilateral on both feet and wrists, perfectly symmetrical in location and size. They have all been excised before only to return some years later. Tradition has it that they were to be "popped" by hitting with a Bible...

• 25 y.o F with prominent bump on R hand for approx 15 years. Recently complains of increased aching and tendon "catching" over bump. Ddx?

• A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis.

• A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back.

• A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days.