JOURNAL OF EVIDENCE BASED MEDICINE AND HEALTHCARE

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Year : 2020 Month : October Volume : 7 Issue : 42 Page : 2439-2441.

Role of Radiology in the Diagnosis of an Uncommon Site of a Common Gossypiboma

Asutosh Dave1, Jitendra Kumar Singh2, Vishal Patel3

1, 2, 3 Department of Radiology, GCS Medical College and Hospital, Ahmedabad, Gujarat, India.

CORRESPONDING AUTHOR

Dr. Jitendra Kumar Singh, 302, Kunj Vihar, Opp. Annexe House, Near Madhuram Tower, Shahibaug, Ahmedabad - 380004, Gujarat, India.
Email : doctorjitendra12@gmail.com

ABSTRACT

PRESENTATION OF CASE

A 53 year old man presented with right sided neck swelling which was tender on palpation along with symptoms such as high grade fever and sweating since 4 days. No significant and relevant personal and family history was present. Patient had a successful operative history for a benign neurogenic tumour in right infratemporal fossa 1.5 months back. Patient was relatively asymptomatic before 10 days. He then gradually developed a swelling at the operative site which sooner became tender and was accompanied with high grade fever 4 days back. Patient also complained of mild restriction of neck movements as well. He then came for detailed examination and then was referred for MRI examination as a part of protocol.

 

Radiological Features

Routine MRI examination showed a well-defined circumscribed lesion at operative site in right infra temporal fossa which appeared to be peripherally thick walled hypo intense in T1W images (green arrow Fig 1) and hyper intense in T2W images (green arrow Fig 2). On further sequences it was noted that a diffuse hypo intense central part is noted in all sequences which was prominent in GRE (Gradient Recalled Echo) images showing again hyper intense thick wall (pink arrow in Fig 3) and central hypo intensity (blue arrow in Fig 3) suggesting multiple air foci. Haemorrhage was excluded in view of lack of T1W hyper intensity. On STIR (Short Tau Inversion Recovery) images no significant other information was gained about the lesion (green arrow in Fig. 4).

Observing the whole examination at first it looked like an abscess but due to lack of diffusion restriction and surrounding soft tissue swelling, this differential is ruled out.

DIFFERENTIAL DIAGNOSIS

  • Recurrent Neoplasm

They appear hypointense in T1W images, hyper intense in T2W images and have an ill-defined margins without any surrounding thick wall and has intense internal vascularity without any air foci.

 

  • Lymphocele

It is purely a cystic structure which doesn’t have any air foci, haemorrhage or solid content.

 

Thus lack of surrounding soft tissue swelling, ill-defined margins, internal necrosis, internal vascularity and haemorrhage led to the final diagnosis of gossypiboma. Post surgically, there was a surgical pad found with significant inflammatory tissue attached to it.

 

 

Figure 1

 

 

Figure 2

 

 

Figure 3