A 52-year-old female presented with a chronic anterior right shoulder pain for 6 months. On examination, a palpable tender mass was found along the anterior aspect of the right shoulder; however, the patient had no history of trauma to the right arm. In addition, a normal range of passive motion and a painful range of motion in flexion and abduction were observed. Magnetic resonance imaging (MRI) of the right shoulder joint revealed a oval-shaped proton density (PD)/T2 hyperintense cystic mass (measuring 15.5 mm × 6 mm) that was encapsulated by the tendon sheath of the long head of the biceps [Figure 1a–d].
Figure 1.
(a-d) Magnetic resonance images of the right shoulder demonstrating a well-defined, lobulated hyperintense lesion (arrow) encapsulated by the tendon sheath of long head of the biceps
QUESTIONS
Q1. Describe the findings in Figure 1a–d
Q2. What is the diagnosis?
ANSWERS
Answer 1
Sagittal oblique PD-weighted fat-suppressed [Figure 1a and b], axial PD-weighted fat-suppressed [Figure 1c] and coronal postcontrast [Figure 1d] MRI are provided. These images demonstrate a well-defined, lobulated fluid-signal intensity lesion with thin rim enhancement, postintravenous contrast originating from the long head of the biceps tendon and encapsulated by its tendon sheath. In Figure 1a and b, magic angle artifact can be observed.
Answer 2
The diagnosis is intratendinous ganglion originating from the long head of the biceps tendon.
DISCUSSION
Intratendinous ganglion cysts are rare and those involving the long head of the biceps tendon are even rarer.[1] Intratendinous ganglion cyst with the common extensor tendon of the middle finger was first reported by Lecene in 1927.[2] Most cases of intratendinous ganglion cysts have been reported in middle-aged women.[3] Differential diagnosis includes bursitis, tenosynovitis, tendon rupture, nerve sheath tumor, synovial sarcoma or pigmented villonodular synovitis.[4]
The most common location for this lesion is dorsum of the wrist, comprising 60% of all ganglion cysts.[5] In the shoulder, ganglion cysts most commonly occur in the spinoglenoid and suprascapular notch. On MRI, the location and anatomical relationship between adjacent muscular structures have a distinctive appearance. Treatment options include conservative management and surgical excision. For intratendinous ganglion originating from the proximal long head of the biceps tendon, ultrasound-guided aspiration may be used as a treatment modality.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the Journal. The patient understands that her name and initials will not be published, and due efforts will be made to conceal her identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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