Yonsei Med J.  2007 Oct;48(5):886-890. 10.3349/ymj.2007.48.5.886.

FDG Uptake in PET by Bladder Hernia Simulating Inguinal Metastasis

• Park SH
• Kim MJ
• Kim JH
• Cho AE
• Park MS
• Kim KW

• KMID: 1122632
• DOI: http://doi.org/10.3349/ymj.2007.48.5.886

Abstract

A 70-year-old man with past history of hemicolectomy due to colon cancer underwent a follow-up abdominal/pelvic CT scan. CT revealed a right adrenal metastasis and then he underwent FDG-PET/CT study to search for other possible tumor recurrence. In PET images, other than right adrenal gland, there was an unexpected intense FDG uptake at right inguinal region and at first, it was considered to be an inguinal metastasis. However, correlation of PET images to concurrent CT data revealed it to be a bladder herniation. This case provides an example that analysis of PET images without corresponding CT images can lead to an insufficient interpretation or false positive diagnosis. Hence, radiologists should be aware of the importance of a combined analysis of PET and CT data in the interpretation of integrated PET/CT and rare but intriguing conditions, such as bladder herniation, during the evaluation of PET scans in colon cancer patients.

Keyword

Bladder hernia; inguinal; bladder; FDG-PET; PET/CT imaging

MeSH Terms

Abdominal Neoplasms/radionuclide imaging/secondary
Aged
Colonic Neoplasms/pathology/radiography/radionuclide imaging
Diagnosis, Differential
False Positive Reactions
Fluorodeoxyglucose F18/*diagnostic use
Hernia, Inguinal/radiography/*radionuclide imaging
Humans
Male
*Positron-Emission Tomography
Radiopharmaceuticals/*diagnostic use
Tomography, X-Ray Computed
Urinary Bladder Diseases/radiography/*radionuclide imaging

Figure

• 

  Fig. 1 Serial axial (A) and coronal (B) FDG PET showed an unexpected an intense FDG uptake in right inguinal region, which was considered to be inguinal nodal metastasis (arrows).

• 

  Fig. 2 Initial abdomen/pelvis CT showed that the right anteroinferior wall of bladder was herniated into the right inguinal canal without contrast enhancement within the herniated sac. The neck of the hernial sac was relatively wide (A and B) and within the hernial sac there was homogeneous cystic low density due to trapped urine without calcification (C and D).

• 

  Fig. 3 Starting from the top, PET (A), CT (B) and fusion images (C) were seen. Intense FDG uptake in right inguinal region resulted from accumulation of FDG in the trapped urine of hernial segment of bladder.

Reference

1. Hustinx R. PET imaging in assessing gastrointestinal tumors. Radiol Clin North Am. 2004. 42:1123–1139. ix

2. Delbeke D, Martin WH. PET and PET-CT for evaluation of colorectal carcinoma. Semin Nucl Med. 2004. 34:209–223.

3. Huebner RH, Park KC, Shepherd JE, Schwimmer J, Czernin J, Phelps ME, et al. A meta-analysis of the literature for whole-body FDG PET detection of recurrent colorectal cancer. J Nucl Med. 2000. 41:1177–1189.

4. Even-Sapir E, Parag Y, Lerman H, Gutman M, Levine C, Rabau M, et al. Detection of recurrence in patients with rectal cancer: PET/CT after abdominoperineal or anterior resection. Radiology. 2004. 232:815–822.

5. Conde Sánchez JM, Espinosa Olmedo J, Salazar Murillo R, Vega Toro P, Amaya Gutiérrez J, Alonso Flores J, et al. Giant inguino-scrotal hernia of the bladder. Clinical case and review of the literature. Actas Urol Esp. 2001. 25:315–319.

6. Koontz AR. Sliding hernia of diverticulum of bladder. AMA Arch Surg. 1955. 70:436–438.

7. Fisher PC, Hollenbeck BK, Montgomery JS, Underwood W 3rd. Inguinal bladder hernia masking bowel ischemia. Urology. 2004. 63:175–176.

8. Ciancio G, Burke GW, Nery J, Huson H, Coker D, Miller J. Positional obstructive uropathy secondary to ureteroneocystostomy herniation in a renal transplant recipient. J Urol. 1995. 154:1471–1472.

9. Catalano O. Computed tomography findings in scrotal cystocele. Eur J Radiol. 1995. 21:126–127.

10. Andac N, Baltacioğlu F, Tüsney D, Cimşit NC, Ekinci G, Biren T. Inguinoscrotal bladder herniation: is CT a useful tool in diagnosis? Clin Imaging. 2002. 26:347–348.

11. Pirson AS, Krug B, Lacrosse M, Luyx D, Barbeaux A, Borght TV. Bladder hernia simulating metastatic lesion on FDG PET study. Clin Nucl Med. 2004. 29:767.

12. Cohade C, Osman M, Leal J, Wahl RL. Direct comparison of (18)F-FDG PET and PET/CT in patients with colorectal carcinoma. J Nucl Med. 2003. 44:1797–1803.

13. Gutman F, Alberini JL, Wartski M, Vilain D, Le Stanc E, Sarandi F, et al. Incidental colonic focal lesions detected by FDG PET/CT. AJR Am J Roentgenol. 2005. 185:495–500.