Persistent FDG Uptake Around an Inguinal Mesh Prosthesis 25 Years After Implantation

Plug inguinal hernia repair mimicking nodal spread of prostate cancer on PSMA-PET/CT

A variety of non-prostatic or non-malignant findings exhibiting prostate specific membrane antigen (PSMA) tracer uptake and resemble metastatic disease on positron emission tomography (PET) imaging. In this case, a 72-year-old man presenting for initial staging of prostate cancer was found to have PSMA tracer uptake along the left external iliac vessels corresponding to a structure resembling a lymph node on computed tomography (CT). This finding was initially concerning for nodal spread of the patient's primary neoplasm. However, chart review revealed a remote history of left inguinal hernia plug repair with location corresponding to the area of PSMA activity. This case highlights PSMA uptake related to surgical mesh from inguinal hernia plug repair as a mimic of nodal metastatic disease on PSMA PET.

18F-FDG PET-CT postoperative changes after maxillectomy: Findings and pitfalls in interpretation

OBJECTIVE

We investigated the findings and pitfalls of FDG-PET/CT scanning after maxillectomy with reconstruction/rehabilitation procedures, in patients with head and neck malignancies treated during nine years at one tertiary medical centre.

METHODS

Fourteen patients (10 males), aged 22-84 years, underwent 17 reconstruction/rehabilitation maxillectomy surgeries and 35 PET/CT scans. Postoperative PET/CT findings were correlated with clinical and imaging follow-up.

RESULTS

Increased FDG uptake, mean SUVmax 2.4 ± 1.4 (range 0.3-4.3), was observed at the postoperative bed following 12 of 17 surgeries (71%; 10 obturators, two mesh reconstructions). Following the remaining 5/17 surgeries (three with a fat flap and two without any reconstructions), abnormal FDG uptake was not observed at the postoperative bed.CT features of postoperative sites included: non-homogeneous mixed iso/hyperdense structures (hollow or filled) with multiple surrounding and/or inside air bubbles ("sponge appearance") and mucosal thickening along the postoperative bed wall (in all cases with obturator implants); rich fat density material in reconstructions with a fat flap and in closures without reconstruction, and radiopaque elongated structures in mesh reconstructions.No correlation was found of the mean SUVmax in initial scans, with the time from the surgery date (10 ± 6 months; r=0.04, P=0.90), or with the mean SUVmax in final scans (at 25± 17 months, P=0.17).

CONCLUSIONS:

Increased FDG uptake, together with corresponding non-specific CT features, may persist for a prolonged period after surgery with obturators and mesh implantations, mimicking malignancy or infection. Awareness of variations in postoperative PET-CT appearance can help avoid false interpretations and redundant invasive procedures.

Increased 18F-FDG Uptake Associated With Gastric Banding Surgical Mesh on PET/CT

Surgical mesh was used in the 1980s and early 1990s for vertical banded gastroplasty as treatment for morbid obesity. This procedure was replaced by the more popular laparoscopic gastric banding in the mid-1990s. Surgical mesh, commonly used in hernioplasty, has been associated with increased F-FDG uptake related to an inflammatory foreign body reaction and is a known cause of false-positive PET scans. We present a case of increased F-FDG uptake related to surgical mesh in a patient who had undergone vertical banded gastroplasty.

PET/US fusion as a problem-solving tool in oncology imaging: differentiation of hernia repair mesh plugs from malignancy suspected on PET/CT

PET/CT is an established modality for evaluation of malignant disease. However, in many cases, specificity is impaired by false-positive findings. Recognition of these cases is crucial for correct diagnosis and subsequent patient management. In the presented case, malignant disease was suspected in a young man because of a history of B symptoms. F-FDG PET/CT showed hypermetabolic foci in both inguinal regions initially classified as possible lymphoma. Using a novel technique for PET/US fusion, ultrasound and PET were coregistered to clarify that PET hypermetabolism was due to a foreign body reaction after plug hernioplasty performed several years earlier.

Intense FDG Uptake around the Inguinal Surgical Mesh 5 Years after Operation: Case Report and Review of the Literature

We present the case of a 40-year-old man who underwent a FDG PET/CT study for restaging of renal cell carcinoma treated with left nephrectomy, for suspected metastasis in lung and retroperitoneal lymph nodes. The patient had a history of left inguinal hernia repair with implantation of mesh prosthesis 5 years ago. PET/CT image revealed linear intense FDG uptake in left inguinal region most likely corresponding to a persistent foreign body reaction. In this article, a case with an intense FDG uptake around mesh prosthesis after many years was reported, and a summary of the literature about surgical mesh and foreign body reaction causing FDG uptake was reviewed.

CONFLICT OF INTEREST

None declared.