Saudi Journal of Medicine and Medical Sciences

IMAGE QUIZ
Year
: 2019  |  Volume : 7  |  Issue : 2  |  Page : 126--129

A cystic mass in the long head of biceps


Reddy Ravikanth, Kanagasabai Kamalasekar 
 Department of Radiology, Holy Family Hospital, Thodupuzha, Kerala, India

Correspondence Address:
Reddy Ravikanth
Department of Radiology, Holy Family Hospital, Thodupuzha - 685 605, Kerala
India




How to cite this article:
Ravikanth R, Kamalasekar K. A cystic mass in the long head of biceps.Saudi J Med Med Sci 2019;7:126-129


How to cite this URL:
Ravikanth R, Kamalasekar K. A cystic mass in the long head of biceps. Saudi J Med Med Sci [serial online] 2019 [cited 2019 Aug 18 ];7:126-129
Available from: http://www.sjmms.net/text.asp?2019/7/2/126/256034


Full Text



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 1]a, [Figure 1]b,[Figure 1]c,[Figure 1]d.{Figure 1}

 Questions



Q1. Describe the findings in [Figure 1]a, [Figure 1]b,[Figure 1]c,[Figure 1]d

Q2. What is the diagnosis?

 View Answer

 Answers



Answer 1

Sagittal oblique PD-weighted fat-suppressed [Figure 1]a and [Figure 1]b, axial PD-weighted fat-suppressed [Figure 1]c and coronal postcontrast [Figure 1]d 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 1]a and [Figure 1]b, magic angle artifact can be observed.{Figure 1}

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.

References

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2Lecene MP. Three cases of pseudocystic gelatinous degeneration of juxta-articular connective tissue and tendon tissue. Bull Mem Soc Nat Chir 1927;53:2.
3Rutten MJ, de Jong MD, van Loon T, Jager GJ. Intratendinous ganglion of the long head of the biceps tendon: US and MRI features (2010: 9b). Intratendinous ganglion. Eur Radiol 2010;20:2997-3001.
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