Suture granuloma
Updates to Article Attributes
Suture granulomas are localizedlocalised inflammatory reactions in response to a retained suture material. UltrasoundA similar process may also occur in certain situations with mesh repairs 5. Ultrasound is often used as first-line imaging modality. It may be confused with a tumour or a recurrent tumour 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 tumour or recurrent tumour.
Pathology
A suture granuloma represents a benign granulomatous proliferation in response to a retained foreign body. They less commonly occure 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 4.
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 colour Doppler
PET/CT
- may be FDG avid, mimicking neoplasm 2
,3-3
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 tumour / metastasis
- abdominal desmoid
- scar endometriosis
- abdominal wall abscess
- abdominal wall haematoma
- inflamed epidermoid cyst (internal hair may mimic suture on ultrasound)
-<p><strong>Suture granulomas</strong> are localized inflammatory reactions in response to a retained suture. Ultrasound is often used as first-line imaging modality. It may be confused with a tumour or a recurrent tumour after surgery and should be considered in the differential in the correct setting.</p><h4>Clinical presentation</h4><p>Usually develops slowly after an intervention. It may become a palpable and tender mass, mimicking tumour or recurrent tumour.</p><h4>Pathology</h4><p>A suture granuloma represents a benign granulomatous proliferation in response to a retained foreign body. They less commonly occure with absorbable sutures, but may still occur.</p><h4>Radiographic features</h4><p>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 <sup>4</sup>.</p><h5>Ultrasound</h5><p>High-frequency (>10 MHz) linear probe is useful.</p><ul>- +<p><strong>Suture granulomas</strong> are localised inflammatory reactions in response to retained suture material. A similar process may also occur in certain situations with mesh repairs <sup>5</sup>. Ultrasound is often used as first-line imaging modality. It may be confused with a tumour or a recurrent tumour after surgery and should be considered in the differential in the correct setting.</p><h4>Clinical presentation</h4><p>Usually develops slowly after an intervention. It may become a palpable and tender mass, mimicking tumour or recurrent tumour.</p><h4>Pathology</h4><p>A suture granuloma represents a benign granulomatous proliferation in response to a retained foreign body. They less commonly occure with absorbable sutures, but may still occur.</p><h4>Radiographic features</h4><p>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 <sup>4</sup>.</p><h5>Ultrasound</h5><p>High-frequency (>10 MHz) linear probe is useful.</p><ul>
-</ul><h5>PET/CT</h5><ul><li>may be FDG avid, mimicking neoplasm <sup>2,3</sup>-</li></ul><h4>Treatment and prognosis</h4><p>The treatment of choice is resection of the retained suture and surrounding inflammatory tissue.</p><h4>Differential diagnosis</h4><ul>- +</ul><h5>PET/CT</h5><ul><li>may be FDG avid, mimicking neoplasm <sup>2-3</sup>
- +</li></ul><h4>Treatment and prognosis</h4><p>The treatment of choice is resection of the retained suture and surrounding inflammatory tissue.</p><h4>Differential diagnosis</h4><p>General imaging differential considerations include</p><ul>
References changed:
- 5. Falagas ME, Kasiakou SK. Mesh-related infections after hernia repair surgery. Clin. Microbiol. Infect. 2005;11 (1): 3-8. <a href="http://dx.doi.org/10.1111/j.1469-0691.2004.01014.x">doi:10.1111/j.1469-0691.2004.01014.x</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/15649297">Pubmed citation</a><span class="auto"></span>
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