KEY FACTS
Terminology
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Ganglion cyst: Myxoid tissue encased in fibroblastic collagenous wall with no synovial lining
Imaging
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Fluid-filled mass with stalk emanating from joint
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Common in wrist but can occur in other joints, including fingers, ankle, knee, hip, and shoulder
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Readily diagnosed with ultrasound by characteristic features
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Contains hypoechoic fluid
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± septations
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± comet-tail artifacts (due to colloid aggregates)
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Very firm, not compressible
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Recent leakage can cause hyperemia and edema of surrounding tissues from inflammatory response
Clinical Issues
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Up to 50% of cysts in adults and > 90% in children; wrist ganglia will resolve without treatment
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Treated with ultrasound-guided aspiration or surgical excision
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Ultrasound-guided aspiration
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Fluid is viscous, larger gauge needle is often required
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Higher success rate alongside flexor tendon sheath, (> 70% vs. 50%)
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Ganglia may become smaller/less symptomatic (partial response)
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Scanning Tips
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Locate tell-tale stalk of cyst and trace it back toward joint of origin
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Note important relationships of cyst (i.e., to tendons and neurovascular bundle)
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Use color Doppler to differentiate from vascular anomaly or nerve sheath tumor, which also appears hypoechoic
arising from a defect in the dorsal capsule of the scapholunate ligament 
. The ligament remains functionally intact.
on the radiovolar aspect of the wrist. The stalk 
of the ganglion extends deeply to lie between the radioscaphocapitate and radiolunotriquetral ligaments 
.
