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Miscellanea
Images in paediatrics
Cystic ganglionosis in an 18-month-old child
  1. Jayne MacMahon1,
  2. Michael James Carter1,
  3. Michael Moore2,
  4. Niamh McSweeney1
  1. 1 Department of Paediatrics and Child Health, Cork University Hospital, Cork, Ireland
  2. 2 Department of Radiology, Cork University Hospital, Cork, Ireland
  1. Correspondence to Dr Jayne MacMahon, Department of Paediatrics and Child Health, Cork University Hospital, Wilton, Cork, Ireland; jaynemacmahon{at}gmail.com

http://dx.doi.org/10.1136/archdischild-2018-315793

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    An 18-month-old girl presented with multiple soft tissue masses on her hands and feet that had developed over the previous 4 months. She was otherwise well and there was no family history of note. On examination, she was noted to have painless multiple soft tissue swellings, varying in size from 0.5 to 4 cm across her phalanxes and the dorsum of her feet (figure 1). These were raised with no overlying skin changes. Ultrasound of her right foot showed multiple well-defined simple fluid structures consistent with ganglion cysts. She had an MRI of her right foot which confirmed multiple simple cysts adjacent to and communicating with the joints of the foot, predominantly the tarus (shown in figures 2 and 3). Differential diagnoses include lipoma, fibroma and ganglion cyst. Due to the multiple affected sites, and typical MRI findings of smooth round masses in close proximity to joints, a diagnosis of cystic ganglionosis was made. Cystic ganglionosis is a benign condition where multifocal soft tissue masses arise adjacent to joints and tendons. It is rare in children, and aetiology is uncertain, but the masses may arise from synovial residue deposited at embryogenesis, degeneration secondary to chronic trauma or proliferation of mesenchymal cells.1 Management is conservative unless there is damage to underlying bone, in which case surgical resection is occasionally indicated.2 3 This article was included as part of the 2018 Paediatric Rheumatology European Society Congress.

    Figure 1
    Figure 1

    Clinical image showing ganglion cysts visible on dorsum right foot, underneath lateral malleolus.

    Figure 2
    Figure 2

    Coronal view of right foot demonstrating multiple ganglion cysts.

    Figure 3
    Figure 3

    Sagittal view of right foot demonstrating multiple ganglion cysts.

    Acknowledgments

    We thank the family of the patient for their permission to report this case.

    References

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    Footnotes

    • Competing interests None declared.

    • Patient consent Parental/guardian consent obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Presented at Paediatric Rheumatology European Society