Granulom an chirurgischen Nähten oder Clips

Suture granulomas are localized inflammatory reactions in response to retained suture material. A similar process may also occur in certain situations with mesh repairs . Ultrasound is often used as a first-line imaging modality. It may be confused with a tumor or a recurrent tumor after surgery and should be considered in the differential in the correct setting.

Clinical presentation

Usually develops slowly after an intervention. It may become a palpable and tender mass, mimicking tumor or recurrent tumor.

Pathology

A suture granuloma represents a benign granulomatous proliferation in response to a retained foreign body. They less commonly occur with absorbable sutures, but may still occur.

Radiographic features

Obtaining a history of prior surgery with a surgical approach around the area of concern is important. Suture granulomas can present in the neck after thyroidectomy, mimicking recurrence .

Ultrasound

High-frequency (>10 MHz) linear probe is useful.

• hypoechoic collection
• a small hyperechoic structure in the collection (the suture) is highly specific
  • often has parallel hyperechoic 'rail-like' morphology
• may show mild vascularity on color Doppler 

PET/CT

• may be FDG avid, mimicking neoplasm

Treatment and prognosis

The treatment of choice is resection of the retained suture and surrounding inflammatory tissue.

Differential diagnosis

General imaging differential considerations include

• recurrent tumor/metastasis
• abdominal desmoid
• scar endometriosis
• abdominal wall abscess
• abdominal wall hematoma
• inflamed epidermoid cyst (internal hair may mimic suture on ultrasound)

Siehe auch:

• verkalkte mesenteriale Lymphknoten
• freie Gewebeformationen peritoneal
• peritoneale Verkalkungen
• intraabdominelle Verkalkungen

und weiter:

• chirurgische Clips