I just saw a patient with a recurrent ganglion of tendon sheath.

She had presented to my office with a large fluid filled mass on top of her right great toe that had been present for three months and was getting larger.  She reported that it rubbed on her shoes and caused pain.

Twice previously I aspirated (sucked out with a needle and syringe) clear gelatinous material from this large ganglion and injected steroid (Kenalog, like cortisone) into the lesion and now twice it has returned.  I scheduled her for surgical excision of the ganglion tomorrow in my office under local anesthesia.  I will make an incision, cut it out and put in stitches.

I didn’t get a clinical photo, but here’s her ultrasound of the ganglion.  It shows up as a large black (hypo-echoic area).  Ultrasound bounces sound waves off of things.  When it hits bone it makes nice white lines.  Soft tissues show up as different shades of gray depending on their density and fluid shows up as black because it doesn’t bounce sound waves off, they go right through the fluid. (click any picture to enlarge