Pictorial essay: USG of lumps and bumps of the foot and ankle

Unusual presentation of an usual condition-cystic ganglionosis

Cystic ganglionosis is an unusual benign condition, which presents as multiple ganglion cysts involving multiple joints. The case we report here is probably the first case of an adult reported in the literature. The only other case of multiple ganglion cysts reported in the literature is that of an 11-year-old child with ganglion cysts in multiple joints. A 57-year-old female presented with an approximately 4-year history of pain and swelling below the left knee and in the right hand. An MRI of the left knee showed multiloculated cystic-intensity lesions around the knee joint with intra-/extra-articular and intraosseous components. Similar lesions were noted around the right knee joint, right wrist and ring finger. With all the above findings and in view of multiple joint involvement, the possibility of cystic ganglionosis or multiple giant ganglion cysts was considered and confirmed by biopsy of one of the knee lesions. It is because of this rarity and the unusual presentation involving multiple joints that we have reported this case. The importance of the diagnosis is that unnecessary surgical intervention and hospitalization can be avoided, provided the patient's symptoms are not severe.

Lumps and bumps around the foot and ankle: an assessment of frequency with ultrasound and MRI

Benign and malignant tumours and tumour-like conditions frequently present as lumps in the foot and ankle. Although definitive histological diagnosis cannot be ascertained short of a biopsy, most entities can be confidently characterised on ultrasound and/or MRI. Masses in the foot and ankle present with lump, pain, paraesthesia, restricted mobility or a combination of these. In this review we have focussed on the relative frequency of masses in the foot and ankle that present as focal lumps, with a brief description of their typical appearance on ultrasound and MRI. Ganglions were the largest group in our series representing 24 % of the masses, followed by tendon- and ligament-related lesions and, bony lesions representing 16 % and 11 % of the masses respectively.