A Case of Compound Palmarganglion Mimicking Giant Cell Tumour

Background: Compound palmar ganglion is a progressive swelling and inflammation of the tendon sheath that distends the sheath proximal and distal to flexor retinaculum. It is a tubercular manifestation of flexor tenosynovitis of the wrist. The patients commonly present with a single swelling in the volar aspect of distal forearm with history of past infection with tuberculosis. Depending on severity bones, joint or tendons may get involved. Diagnosis is based on history, clinical findings, lab investigations and radiographs. Clinically the swelling is ill defined or well defined, cross fluctuation may be positive, with local rise in temperature. Lab findings will reveal raised ESR and CRP. If the bones are involved it will show cystic changes with erosion and arthritis. Treatment depends on the severity of the disease. It can be managed both conservatively and surgically however in this case we have gone with a combination of both surgery and medications. Case Presentation: A 68 year old female presented to KURLA BABHA HOSPITAL OPD with complaints of multiple swelling in the volar aspect of left distal forearm since 3 weeks and it was gradually increasing in size. She had evening rise of temperature, with loss of apatite and loss of weight. She had history of pulmonary tuberculosis 5 months back but was not taking medications for the same. Blood investigations were carried out and radiographs were done. Ultrasound of the swelling revealed infected ganglion cyst. MRI of the wrist joint was done to rule out giant cell tumour which revealed infective arthritic changes involving the wrist joint and carpal bones. The patient did not follow up for 7 days. Later she came to the OPD with pus discharge from the swelling on the volar aspect of distal forearm. The localised temperature was raised. She was admitted in the ward and was posted for surgery the following day. Thorough debridement was done . Pus and tissue samples were collected and sent for culture, histopathology examination. The incisions were kept open and sterile dressing was done. She was started on anti tubercular drugs until her reports were awaited. Conclusion: The diagnosis of compound palmar ganglion is usually delayed because it mimics many other infective or inflammatory conditions which can lead to complications. It is a rare complication of primary tuberculosis and is more common in men. Diagnosis in early stage may be difficult but is based on history, examination, blood and radiological investgations. MR imaging will allow assessment of the entire tendon and sheath and helps to rule out infection, inflammation or neoplasia. Biopsy, histopathological examination and culture of organism are the confirmatory test. Early wide excision of the infected tissues combined with antituberculous multidrug therapy gives good functional results and prevents recurrence.