Disclosures: Nicole V. Nguyen, DO: No financial relationships or conflicts of interest

Case Diagnosis: 39-year-old male with history of multiple gunshot wounds to the head and neck with more than 10 surgeries presenting with right neck swelling and discomfort

Case Description: The patient initially presented with right neck swelling and discomfort as well as right axillary and second digit symptoms which improved with gabapentin, but worsened with activity. Examination revealed 5/5 strength in all extremities, intact light touch sensation, 2+ reflexes in bilateral upper and lower extremities, negative Hoffman’s, and no increased tone. He was tender along his right sternocleidomastoid, scalene, and cervical paraspinals. He also exhibited slightly decreased muscle bulk in his right shoulder and mild right scapular dyskinesia.

Setting: Outpatient Sports Medicine ClinicAssessment/

Results: EMG was normal with no evidence of right median mononeuropathy, right upper limb polyneuropathy, or right spinal accessory mononeuropathy. CT of the neck with contrast was negative, however ultrasound of his right anteriorolateral neck showed an encapsulated anechoic non-compressible mass. It was thought to be an intraneural ganglion cyst with mass effect on the brachial plexus. He was then referred to plastic surgery for resection.

Discussion: Intraneural ganglion cysts are non-neoplastic mucinous lesions which can be found within the epineurium of a nerve and can lead to compressive neuropathies. Diagnosis of intraneural ganglion cysts typically involve ultrasound or MRI but can also be made with CT. Because the currently accepted theory is that the cyst origin is through an articular branch of the nerve supplying a joint, it is recommended that the articular branch be ligated to deprive the cyst of its fluid source.

Conclusion: In this case, ultrasound was able to detect the encapsulated noncompressible mass that was not seen on the CT scan, prompting earlier treatment and intervention. Thus, ultrasound should be considered as an early, alternative diagnostic modality for similar clinical presentations and/or when intraneural ganglion cysts are suspected.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/ultrasound-as-a-diagnostic-modality-in-identifying-an-intraneural-ganglion-cyst-a-case-report/