Hemorrhagic lumbar synovial cysts are not commonly reported in English literature. Post-resection recurrence of synovial cyst is unusual and therefore recurrence symptoms required repeat MRI or CT scan. We reported a case of hemorrhagic lumbar synovial cyst presented with neurological deficit that recovered initially after surgery but subsequently developed recurrent of symptoms at a higher level due to fibrous tissue.
A 32 year-old Malay lady presented with a swelling over the dorsal surface of her right thumb for 6 months. The swelling was non-tender, smooth surfaced, mobile and nonfluctuating with no bony involvement. The provisional diagnosis was ganglion cyst. Excisional biopsy did not show features of ganglion cyst as it appeared to be wellencapsulated, multi-lobulated and yellowish in colour. Histopathological examination showed that it was a schwannoma. Schwannomas are relatively rare benign tumours which are frequently misdiagnosed. In this case, it was misdiagnosed both as a ganglion and a lipoma.
The widespread use of MRI in the assessment of low back pain has led to increased detection of degenerative cysts of the spine, which was essentially a surgical diagnosis earlier. The awareness of degenerative cysts, the significance of their role in the etiology of radicular and back pain and their effective management is evolving. We describe a case of bilateral, gas-filled lumbar facet synovial/ ganglion cysts causing focal arachnoid inflammation and lateral lumbar canal stenosis.
Juxtafacet cyst of the spine is a rare occurrence. Reports have described them as synovial cysts; ganglion cysts; extradural cysts as well as degenerative cysts of the spine. Patients may present with radicular pain, motor deficits, sensory disturbances, cauda equina syndrome and even myelopathy. Lumbar juxtafacet cysts may be confused clinically with prolapsed intervertebral discs or other conditions involving nerve root compression such as arachnoid cysts, ependymal cysts, dermoid cysts or teratomatous cysts. In the case of the juxtafacet cyst, surgical excision is usually curative. We report a case of spinal synovial juxtafacet cyst found intraoperatively in a case that was preoperatively diagnosed as prolapsed intervertebral disc. Synovial juxtafacet cyst of the spine should be considered as one of the differential diagnoses in patients, especially in older patients, presenting with nerve root compression.
We present the case of a 56-year old gentleman who presented with recalcitrant iliotibial band (ITB) friction syndrome which did not improve with various modalities of conservative treatment. Magnetic Resonance Imaging (MRI) of the affected knee did not show pathology typical of ITB friction syndrome. However, open exploration revealed a synovial cyst deep to the iliotibial band, abutting against the anterolateral capsule. The presence of distinctive clinical signs on physical examination should alert clinicians to consider knee synovial cyst as a differential diagnosis when dealing with recalcitrant ITB syndrome.