DOI:10.2214/AJR.07.3543
AJR 2008; 190:W382
© American Roentgen Ray Society
Diagnosis of Gossypiboma of the Abdomen and Pelvis
Colm F. Murphy,
Helen Stunell and
William C. Torreggiani
Adelaide & Meath Hospitals Incorporating the National Children's
Hospital, Tallaght, Dublin, Ireland
WEB— This is a Web exclusive article.
We read with interest the excellent report by Kim et al.
[1] in which the authors
describe their experience with MRI in the diagnosis of gossypiboma in the
abdomen and pelvis in four patients. We found their report informative and
well written and agree with the authors that MRI is an excellent technique in
the imaging of patients with gossypiboma, despite its rare occurrence.
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Fig. 1A —66-year-old woman with left flank pain and high-grade
pyrexia. Axial CT scan of abdomen and pelvis with oral and IV contrast
administration shows 5 x 4 cm soft-tissue mass anterior to left psoas
muscle, which did not enhance after IV contrast administration.
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Fig. 1B —66-year-old woman with left flank pain and high-grade
pyrexia. Axial contrast-enhanced MR image shows enhancement of peripheral wall
with serrated contour in inner border with unenhanced central cavity.
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The authors describe in detail the characteristic MRI features of
gossypiboma in the abdomen and pelvis, which include the delineation of a
well-defined mass with a peripheral wall of low signal intensity on T1- and
T2-weighted imaging, with whorled stripes seen in the central portion and
peripheral wall enhancement after IV gadolinium administration on T1-weighted
imaging [1]. We recently
encountered a similar case in our institution, which was initially imaged on
CT. Our patient was a 66-year-old woman who presented with left flank pain and
high-grade pyrexia. She had a history of total abdominal hysterectomy and
bilateral salpingo-oophorectomy 10 years previously for endometrial carcinoma.
Urine culture grew Escherichia coli and a presumed diagnosis of
left-sided pyelonephritis was made. However, despite 72 hours of treatment,
her symptoms failed to improve and IV contrast-enhanced CT of the abdomen was
performed. CT showed a 5 x 4 cm soft-tissue mass in the region of the
left psoas muscle (Fig.
1A).
In our case, there was no enhancement of the lesion on CT, making the
diagnosis difficult. However, on MRI, a well-defined mass with a serrated
contour in its inner border showing peripheral enhancement after IV gadolinium
administration (Fig. 1B) was
present in a similar fashion as that described by Kim et al.
[1]. This combined with the
presence of a whorled, striped (Figs.
1C and
1D) appearance suggested the
diagnosis of a gossypiboma, which was confirmed at surgery. We therefore think
that this case adds further credence to the series by Kim et al. in showing
the utility of MRI in the evaluation of patients with retained intraabdominal
surgical gauze or textiloma.
In summary, we congratulate Kim et al.
[1] on their excellent report
in which they describe the characteristic MRI findings in four patients with
gossypiboma of the abdomen and pelvis. We think that our case further adds to
those described by the authors in highlighting the advantages of MRI over
other cross-sectional techniques such as CT in making a diagnosis.
References
- Kim CK, Park BK, Ha H. Gossypiboma in abdomen and pelvis: MRI
findings in four patients. AJR 2007;189
: 814-817[Abstract/Free Full Text]
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