Mimicker: Inguinal Mesh Plug

Left inguinal mesh plug with a lobular contour

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

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.