Wednesday, March 2, 2016

Mimicker: Inguinal Mesh Plug

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.
  • 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