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Ginger Bryant, MD, Prasit Nimityongskul,
MD, Frederick Meyer, MD, Frank Greiner, MD, Elizabeth Manci,
MD, University of South Alabama, Mobile, AL
Ganglion cysts are the most common
cause of soft tissue masses in the hand. The etiology of these
cysts is unclear. However, they commonly arise from synovial
joints and tendon sheaths. The diagnosis of a ganglion cyst
is often assumed after physical examination and is usually
confirmed with aspiration, ultrasound, or excision. On occasion,
however, the assumed diagnosis is incorrect and surgeons find
themselves excising and treating different forms of pathology.
This case involves a ten-year
old boy who presented with the chief complaint of an enlarging
mass on the volar-ulnar surface of his wrist. He denied any
history of trauma. Physical examination revealed a cystic,
non-pulsatile mass superficial to the flexor carpi ulnaris
tendon at the wrist flexion crease. All physical findings
were consistent with a volar wrist ganglion. Routine magnetic
resonance imaging findings were also consistent with a ganglion
cyst. Excision of the presumed ganglion cyst revealed an ulnar
artery aneurysm. Ligation of the artery left the patient with
a pain-free, neurovascularly intact hand. Ulnar artery aneurysms,
while certainly very rare, must be considered as a possible
cause of a mass on the volar surface of the wrist.
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