Tag Archives: Devices

Mimicker: Inguinal Mesh Plug

Depending on the inguinal hernia repair method chosen, a mesh plug can be used for reinforcement. One such method uses a polypropylene (Prolene) plug

    • The post-operative appearance of an inguinal mesh plug can masquerade as an inguinal mass or lymphadenopathy

Imaging Findings

    • On CT, mesh plugs can have a slightly nodular or smooth outline. The density is similar to sightly lower than muscle. Mesh plugs have also been reported as a ring-like density with central fat attenuation, potentially mimicking epiploic appendicitis if on the left
    • On MRI, mesh plugs are typically T1 hypointense and demonstrate variable T2 weighted signal
    • Due to a granulomatous reaction, mesh plugs can be FDG avid

Helpful hints in preventing misdiagnosis

    • Mutliplanar reformations can be useful in demonstrating the conical morphology of the mesh plug, although they can appear ovoid
    • Postsurgical changes including skin thickening and suceptabliity artifact can also be helpful imaging features
Ryan Schwope mesh plug
Left inguinal mesh plug with a lobular contour
Ryan Schwope mesh plug cor
Left inguinal mesh plug. Note conical morphology on this coronal MPR.

References

The British Journal of Radiology, 77 (2004), 261–265
J Comput Assist Tomagr. 2008Jul-Aug;32(4):529-32.
American Journal of Roentgenology. 2010;195: 701-706.

Endologix Stent-graft

 

Most endostent devices used for endovascular repair of aortic aneurysms have the graft material sutured on the luminal side of the stent. The AFX endostent device (Endologix, Irvine, California) is different from other devices in that the graft material is sutured on the outside of the metal component, attached only at the proximal and distal ends.

Delayed CT shows the smoothly marginated contrast extending beyond the confines of the metal strut Ryan Schwopeunchanged in size and configuration when compared to arterial phase imaging

 

By intent, the graft material of the AFX stent-graft can separate from the metal struts where it is not directly apposed to the aortic wall.  During surveillance with contrast-enhanced imaging of patients who have reviewed this device, contrast can be detected outside of the metallic construct. Although this finding can imply a type 1 or 3 endoleak when identified with other endostents, it is a normal finding with the AFX device.

Avoiding misinterpretation as an endoleak can be achieved by confirmation of the type of endostent device used for aneurysm repair. In addition, the contrast extending beyond the metal struts does not change in configuration or size on delayed imaging.

References:

J Vasc Interv Radiol. 2012 Nov;23(11):1544-6.