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Tarlov cysts are cystic structures of neurogenic origin that arise most commonly in the roots of the sacrococcygeal nerves. Prompt and correct identification can prevent unnecessary biopsy of the cysts, a procedure which can cause significant pain because they contain nerve fibers and ganglion cells. We report two cases of Tarlov cysts mimicking adnexal masses on ultrasound evaluation. The first case was misidentified on an ultrasound before being diagnosed as a Tarlov cyst during follow-up magnetic resonance imaging. The second case was initially identified by the sonographer as an ovarian cyst but was properly identified through correlation with prior computed tomography imaging. In this case series, we discuss the pathologic and radiographic features, etiology, clinical considerations, and treatment of Tarlov cysts.

ObjectiveResponse to the coronavirus disease 2019 (COVID-19) pandemic has resulted in shelter-in-place orders and major changes to individuals' daily lives. The impact of such stressors on disease activity in individuals with axial spondyloarthritis (axSpA) is unclear. The aim of this study is to examine whether stress, anxiety, and depression are associated with patient-reported disease activity, after accounting for important factors.MethodsWe administered a survey to an axSpA cohort from a single center with well-defined demographic and disease characteristics. We included questions about job status changes, exercise, medication use, disease activity (by the Bath Ankylosing Spondylitis Disease Activity Index [BASDAI]), and psychological factors (stress, depressive symptoms, and anxiety). Separate multivariable linear models examined the associations between perceived stress, anxiety, and depression with the BASDAI.ResultsAfter adjustment for potential confounders, those with higher levels of stress had a statistically significant 0.54-point higher BASDAI, on average, compared with those with lower levels of stress (95% confidence interval [CI]: 0.11, 0.97). Those with higher levels of anxiety also had a statistically significant higher BASDAI, on average, compared with those with lower levels of anxiety (β: 0.95, 95% CI: 0.18, 0.99). The association between depression and BASDAI was not statistically significant. We did not find differences in these associations among subgroups of age, job status, or county of residence.ConclusionIndividuals with axSpA with higher levels of stress and anxiety had significantly higher disease activity levels, although with a difference below clinical importance. Further planned studies will evaluate the trajectory of disease activity.