Correct answer 1: b
Correct answer 2: b
Reason
Ganglions are the most common hand lesion. They are mucous-filled, fibrous-lined cysts that occur most commonly on the dorsum of the wrist at the level of the scapholunate joint but can occur in other locations such as the radial volar aspect of the wrist. Ganglions can also arise from the tendon sheath at the metacarpophalangeal or proximal phalangeal level. Approximately one-third of ganglions are simple on ultrasound, that is, anechoic with a well-defined but imperceptible wall, and posterior acoustic enhancement (1). The remainder are complex and may contain internal echoes, septations, a thick wall, or may be multiloculated. If a ganglion ruptures and decompresses, it can have a solid appearance although this is unusual.
Ganglions can be treated conservatively or surgically. Conservative treatment may involve the use of a splint, nonsteroidal anti-inflammatory drugs, or aspiration and steroid injection. However, ganglions can recur after aspiration. Cure rates have been reported between 15-89% (2). If surgical excision of the cyst is performed, it is very important to identify the neck of the cyst on ultrasound for complete resection; otherwise, it may recur.
REFERENCES
1. Teefey SA, Dahiya N, Middleton WD, Gelberman RH, Boyer MI. Ganglia of the hand and wrist: A sonographic analysis. AJR 2008; 191:716-720.
2. Nahra ME, Bucchierri JS. Ganglion cysts and other tumor related conditions of the hand and wrist. Hand Clin 2004; 20:249-260.
