Age / Sex : 50 / M

Chief complaint : Abdominal wall mass

Excisional biopsy was performed for the abdominal wall mass 10 years ago and the pathologic 

diagnosis was something benign.


What is your diagnosis?

Two weeks later, you can see the final diagonosis with a brief discussion of this case (Please submit only one answer).


Courtesy : 이승현/Seung Hyun Lee, 국민건강보험공단 일산병원/National Health Insurance Service Ilsan Hospital

Gossypiboma (textiloma)

Discussion

Findings:

A well-defined soft tissue mass at the left upper abdomen wall that is located underneath the external oblique muscle. The mass is containing a wavy internal echo and posterior shadowing on US. The lesion shows heterogeneous signal intensity with whorled stripes of low signal intensity on T2-weighted image and peripheral enhancement with a serrated border on MRI.

Differential Diagnosis:

Foreign bodies like these can often mimic tumors or abscesses clinically and/or radiologically.

Discussion:

Gossypiboma and textiloma are nonmedical terms used to describe a mass of cotton matrix that is left behind in a body cavity during an operation. Gossypibomas cause two types of responses in the body: exudative and aseptic fibrous. The latter can have adhesions, encapsulation, and eventually, granuloma formation. However, the former usually occurs early in the postoperative period and may involve secondary bacterial contamination. Treatment of choice is re-operation and removal of the gossypiboma.

Imaging features

- US: A well-delineated mass containing a wavy hyperechoic internal echo with a hypoechoic rim and strong posterior acoustic shadowing. 

- CT: A whorl-like spongiform low-density heterogeneous mass with a thin enhancing capsule. The mass often shows spongiform pattern containing air bubbles and calcifications and may contain wavy striped high-density areas that represent the sponge itself.

- MRI: Signal characteristics vary depending on the content and stage.

• T1: typically low signal


• T2: low signal with whorled stripes in the central portion


• T1 C+ (Gd): enhancement and in some cases a serrated border to the inner wall

References:

• Imaging of Gossypibomas: Pictorial Review. AJR Am J Roentgenol 2009; 193:S94-S101.


• https://radiopaedia.org/articles/gossypiboma