Iliopectineal Ganglion: A Rare Cause of Lower Extremity Swel
An 80-year-old Japanese woman came to the hospital with the complaint of gradual-onset swelling of the entire right lower extremity which had been swollen for 3 months. Along with mild dullness in the same leg.

The USG did not show venous thrombi, but it did show a cystic lesion measuring 3-4 cm in diameter posterior to the right femoral vein. Although no significant findings were seen on an initial anteroposterior CT scan and MRI of the right hip revealed, in both low T1-weighted and high T2-weighted signal intensity, a cystic lesion arising from the anteromedial aspect of the acetabulum was seen.

A needle aspiration of the cyst was performed with a 21-gauge needle under the guidance of an x-ray image intensifier while also performing ascending venography. Aspiration yielded approximately 6 ml of clear, jelly-like fluid. Venography revealed external compression and narrowing of the right external iliac/femoral vein. Venous flow proximal to the portion of the compression was restored immediately after aspiration, and the swelling in the lower extremity decreased. Hence, there was no need to extirpate the ganglion cyst

By 7.5 years after aspiration, swelling had not recurred in the lower extremity, though MRI showed that the cyst had remained at a small size.

Learning points :-
1. Treatment of ganglion cysts depends on their size, location, and symptoms, and options include observation, needle aspiration, and surgical extirpation.
2. Asymptomatic cysts are often treated with observation. Once a cyst in the hip joint causes compressive symptoms, the ideal treatment is surgical excision because the recurrence rate for cysts treated with needle aspiration is high. However, needle aspiration is easier to perform and is less invasive than surgery
3. Compression of the femoral or iliac vein causes leg swelling resembling that caused by deep vein thrombosis or lymphatic edema.
4. Ganglion cysts of the hip joint are not common and are usually accompanied by hip disorders such as rheumatoid arthritis or osteoarthritis, or by trauma.

Source: https://jmedicalcasereports.biomedcentral.com/articles/10.1186/s13256-019-2223-4
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