Age / Sex : 79 / M

Gossypiboma

Discussion

Answer:

Gossypiboma

Findings:

1) Axial CT
:

Approximately
2cm sized mass involving the spinous process and left paraspinal muscle at L4
level

-
well-defined margin and expansile feature

- high density
within the mass

2) Axial MRI
:

low signal
intensity on T1WI and T2WI with peripheral contrast enhancement

Differential Diagnosis: Nerve sheath tumor, Osteoblastoma, Chondroblastoma

Discussion:

Gossypiboma
is a rare surgical complication with an estimated incidence of 1/1,000 to
1/10,000 per operation. Gossypiboma is an aseptic foreign body reaction with
fibrosis and granuloma formation secondary to retained surgical sponges. In
rare instances, gossypiboma
can clinically and/or radiologically mimic spinal tumors.

1)
Classification

a) Acute necrotic : exudative reaction,
abscess formation, skin fistulas à
symptomatic in the early postoperative period D/Dx) hematoma, non-foreign body
abscess

b) Chronic : adhesions, encapsulation à
foreign-body granuloma in the delayed period D/Dx) tumor

2) Imaging findings

a) Radiograph

- Radiopaque barium sulfate markers

- Whirl-like pattern with or without
radiopaque markers

b) CT

- Modality
of choice

- Spongiform pattern formed by gas
bubbles

- Low-density mass with a fine,
high-density capsule containing contrast agent

c) MRI

- Variable signal
intensity : depending on fluid and protein content in the lesion

References:

1.
Okten AI, Adam M, Gezercan Y. Textiloma: A case of foreign body mimicking a
spinal mass. Eur Spine J 2006;15 Suppl 5:626-9.

2.
Bakan S, Kandemirli SG, Kuyumcu G, Ersen E,
Tutar O. Intrathoracic gossypiboma after spinal operation. Ann Thorac Surg. 2015
Feb;99(2):e37-9