Ganglion cyst
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Ganglion cysts are non-malignant tumour-like cystic lesions 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.
Epidemiology
As a crude over generalisation, they can be considered to most commonly occur in young women (especially in and around the hand).
Clinical presentation
They can cause a myriad of symptoms dependant on location and these are best discussed under location specific sub sites.
Pathology
Their aetiology 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.
Location
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 include1:
- 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:
- knee, e.g. ACL ganglion cyst
- spinoglenoid notch
-: spinoglenoid notch ganglion cyst - ankle
-: foot
Classification
There are many ways of classifying ganglion cysts
In relation to structure, e.g bone. 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. joint
- within the joint
-: intra-articular ganglion cyst - adjacent to a joint
-: juxta-articular ganglion cyst
Radiographic features
Ultrasound
The vast majority are anechoic to hypo-echoichypoechoic on ultrasound and well defined 3,5. Many may demonstrated presence of locules as well as acoustic enhancement 5.
MRI
Usually seen as a unilocular or multilocular rounded or lobular fluid signal mass is seen 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 characeristics include:
-
T1
-: typically ganglia are low signal although high proteinaceous content or haemorrhage can result in lesions appearing isointense or hyperintense on T1 weighted images. -
T2 / STIR:
-typically high signal
EtymologyHistory and etymology
Ganglion cysts are thought to be first described by Hippocrates as ‘‘knots of tissue containing mucoid flesh’’.
Differential diagnosis
General imaging differential considerations include:
-
synovial cyst
- these: these have a synovial lining, are histologically distinct from ganglia but are indistinguishable on imaging 1
-<p><strong>Ganglion cysts</strong> are non-malignant tumour-like cystic lesions that occur in association with musculoskeletal structures <sup>6</sup>. They are sometimes also simply referred to as ganglia or a ganglion, but should not be confused with the anatomical term <a href="/articles/ganglion">ganglion</a>.</p><h4>Epidemiology</h4><p>As a crude over generalisation, they can be considered to most commonly occur in young women (especially in and around the hand). </p><h4>Clinical presentation </h4><p>They can cause a myriad of symptoms dependant on location and these are best discussed under location specific sub sites.</p><h4>Pathology</h4><p>Their aetiology is unclear; they may represent sequelae of synovial herniations or coalescence of small degenerative cysts arising from the tendon sheath, joint capsule or <a href="/articles/bursae">bursae</a>.</p><p>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 <sup>4</sup>. </p><h5>Location</h5><p>They can occur within muscles, menisci and tendons (<a href="/articles/intratendidinous-ganglion-cysts">intratendidinous ganglion cysts </a><sup>6</sup>).</p><h6>According to anatomy</h6><p>They can occur in numerous locations but most commonly (70-80 % of cases) occur in relation to the hand or wrist (<a href="/articles/ganglion-cysts-of-the-hand-and-wrist">ganglion cysts of the hand and wrist</a>) in this location, notable specific sub sites include<sup>1</sup>:</p><ul>- +<p><strong>Ganglion cysts</strong> are non-malignant tumour-like cystic lesions that occur in association with musculoskeletal structures <sup>6</sup>. They are sometimes also simply referred to as ganglia or a ganglion, but should not be confused with the anatomical term <a href="/articles/ganglion">ganglion</a>.</p><h4>Epidemiology</h4><p>As a crude over generalisation, they can be considered to most commonly occur in young women (especially in and around the hand). </p><h4>Clinical presentation </h4><p>They can cause a myriad of symptoms dependant on location and these are best discussed under location specific sub sites.</p><h4>Pathology</h4><p>Their aetiology is unclear; they may represent sequelae of synovial herniations or coalescence of small degenerative cysts arising from the tendon sheath, joint capsule or <a href="/articles/bursae">bursae</a>.</p><p>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 <sup>4</sup>. </p><h5>Location</h5><p>They can occur within muscles, menisci and tendons (<a href="/articles/intratendidinous-ganglion-cysts">intratendidinous ganglion cysts </a><sup>6</sup>).</p><h6>According to anatomy</h6><p>They can occur in numerous locations but most commonly (70-80% of cases) occur in relation to the hand or wrist (<a href="/articles/ganglion-cysts-of-the-hand-and-wrist">ganglion cysts of the hand and wrist</a>) in this location, notable specific sub sites include<sup>1</sup>:</p><ul>
-<li>knee, e.g <a href="/articles/acl-ganglion-cyst">ACL ganglion cyst</a>- +<li>knee, e.g. <a href="/articles/acl-ganglion-cyst">ACL ganglion cyst</a>
-<li>spinoglenoid notch - <a href="/articles/spinoglenoid-notch-ganglion-cyst">spinoglenoid notch ganglion cyst</a>- +<li>spinoglenoid notch: <a href="/articles/spinoglenoid-notch-ganglion-cyst">spinoglenoid notch ganglion cyst</a>
-<li>ankle - foot</li>-</ul><h5>Classification</h5><p>There are many ways of classifying ganglion cysts</p><h6>In relation to structure, e.g bone</h6><ul>-<li>within bone - <a href="/articles/intraosseous-ganglion-cyst">intraosseous ganglion cyst</a>- +<li>ankle: foot</li>
- +</ul><h5>Classification</h5><p>There are many ways of classifying ganglion cysts</p><h6>In relation to structure, e.g. bone</h6><ul>
- +<li>within bone: <a href="/articles/intraosseous-ganglion-cyst">intraosseous ganglion cyst</a>
-<li>adjacent to bone - <a href="/articles/periosteal-ganglion-cyst">periosteal ganglion cyst</a> - rare and may occur more frequently in males <sup>4</sup>- +<li>adjacent to bone: <a href="/articles/periosteal-ganglion-cyst">periosteal ganglion cyst</a> - rare and may occur more frequently in males <sup>4</sup>
-<li>away from bone - <a href="/articles/soft-tissue-ganglion-cyst">soft tissue ganglion cyst</a>- +<li>away from bone: <a href="/articles/soft-tissue-ganglion-cyst">soft tissue ganglion cyst</a>
-</ul><h6>In relation to structure, e.g joint</h6><ul>-<li>within the joint - <a href="/articles/intra-articular-ganglion-cyst">intra-articular ganglion cyst</a>- +</ul><h6>In relation to structure, e.g. joint</h6><ul>
- +<li>within the joint: <a href="/articles/intra-articular-ganglion-cyst">intra-articular ganglion cyst</a>
-<li>adjacent to a joint - <a href="/articles/juxta-articular-ganglion-cyst">juxta-articular ganglion cyst</a>- +<li>adjacent to a joint: <a href="/articles/juxta-articular-ganglion-cyst">juxta-articular ganglion cyst</a>
-</ul><h4>Radiographic features</h4><h5>Ultrasound</h5><p>The vast majority are anechoic to hypo-echoic on ultrasound and well defined <sup>3,5</sup>. Many may demonstrated presence of locules as well as acoustic enhancement <sup>5</sup>.</p><h5>MRI</h5><p>Usually seen as a unilocular or multilocular rounded or lobular fluid signal mass is seen 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. </p><p>Signal characeristics include</p><ul>- +</ul><h4>Radiographic features</h4><h5>Ultrasound</h5><p>The vast majority are anechoic to hypoechoic on ultrasound and well defined <sup>3,5</sup>. Many may demonstrated presence of locules as well as acoustic enhancement <sup>5</sup>.</p><h5>MRI</h5><p>Usually seen as a unilocular or multilocular rounded or lobular fluid signal mass is seen 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. </p><p>Signal characeristics include:</p><ul>
-<strong>T1 -</strong> typically ganglia are low signal although high proteinaceous content or haemorrhage can result in lesions appearing isointense or hyperintense on T1 weighted images.</li>- +<strong>T1: </strong>typically ganglia are low signal although high proteinaceous content or haemorrhage can result in lesions appearing isointense or hyperintense on T1 weighted images.</li>
-<strong>T2 / STIR</strong> - typically high signal </li>-</ul><h4>Etymology</h4><p>Ganglion cysts are thought to be first described by <strong>Hippocrates</strong> as ‘‘knots of tissue containing mucoid flesh’’. </p><h4>Differential diagnosis</h4><p>General imaging differential considerations include</p><ul><li>-<a href="/articles/synovial-cyst">synovial cyst</a> - these have a synovial lining, are histologically distinct from ganglia but are indistinguishable on imaging <sup>1</sup>- +<strong>T2 / STIR: </strong>typically high signal </li>
- +</ul><h4>History and etymology</h4><p>Ganglion cysts are thought to be first described by <strong>Hippocrates</strong> as ‘‘knots of tissue containing mucoid flesh’’. </p><h4>Differential diagnosis</h4><p>General imaging differential considerations include:</p><ul><li>
- +<a href="/articles/synovial-cyst">synovial cyst</a>: these have a synovial lining, are histologically distinct from ganglia but are indistinguishable on imaging <sup>1</sup>
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