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25b - Answer: 19-year-old female presents with history of ganglion cyst

Pomeranz, Stephen
Stephen J Pomeranz, MD
Chief Medical Officer, ProScan Imaging. Founder, MRI Online
Includes DICOM files

HISTORY: 

This 19-year-old female presents with history of ganglion cyst removed eight years prior. Assess for recurrent dorsal ganglion in right wrist. 

(QUIZ ANSWER) IS A FINDING IN THIS CASE: 

None of the above.

Using the diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.

FINDINGS:

Carpal capsulitis. 

Normal ulnar variance posture. 

Triangular fibrocartilage shows no evidence of a tear. No tear in the scapholunate or lunatotriquetral ligaments. Carpal alignment is normal. Carpal bone alignment is normal. Dorsal extensor tendons and flexor tendons in the carpal tunnel show no abnormal signal. Median nerve in the carpal tunnel, ulnar nerve and Guyon's canal unremarkable.

Post-arthrogram images show contrast opacifying filling the proximal carpal joint space. No extravasation of contrast into the midcarpal space to suggest lunatotriquetral or scapholunate ligament tear. Triangular fibrocartilage is unremarkable. Contrast opacifies the pre-styloid recess mimicking the appearance of a ganglion cyst. Pisotriquetral contrast opacification is normal. Contrast in the extensor carpi radialis and brevis tendon sheath / EPL (extensor pollicis longus) could represent a traumatic communication between the tendon sheath and joint space or less likely from the procedure. The former is favored. No evidence of a ganglion cyst. 

Muscles show no abnormal signal. Normal hyperintense signal of the tendons. 

Pisotriquetral recess fluid likely normal. Prestyloid recess may be inflamed.

Fluid in the extensor compartment could be from capsular distention or tenosynovitis. No recurrent ganglion cyst is seen. 

CONCLUSION:

1. Contrast in the extensor carpi radialis and brevis tendon sheath / EPL (extensor pollicis longus) may represent a traumatic communication between the tendon sheath and joint space or less likely from the procedure. The former is favored.

2. 2nd / 3rd compartment tenosynovitis, inflamed capsule. Capsular distention, capsulitis or ganglion with tenosynovitis. Prestyloid recess may be inflamed.

LESSON 2, TOPIC 75

Case Challenge: Wrist MRI Cases

Case Challenge

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Content reviewed: September 28, 2021

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