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LETTER TO EDITOR
Year : 2013  |  Volume : 28  |  Issue : 2  |  Page : 127-128  

Incidentally detected vesico inguinal hernia on fluoro-deoxy glucose positron emission tomography-computed tomography


Department of Nuclear Medicine and PET-CT, Amala Institute of Medical Sciences, Thrissur, Kerala, India

Date of Web Publication16-Sep-2013

Correspondence Address:
Chidambaram Natrajan Balasubramanian Harisankar
Department of Nuclear Medicine and PET-CT, Amala Institute of Medical Sciences, Amala Nagar, Thrissur - 680 555, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-3919.118262

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How to cite this article:
Harisankar CN. Incidentally detected vesico inguinal hernia on fluoro-deoxy glucose positron emission tomography-computed tomography. Indian J Nucl Med 2013;28:127-8

How to cite this URL:
Harisankar CN. Incidentally detected vesico inguinal hernia on fluoro-deoxy glucose positron emission tomography-computed tomography. Indian J Nucl Med [serial online] 2013 [cited 2019 Dec 16];28:127-8. Available from: http://www.ijnm.in/text.asp?2013/28/2/127/118262

Sir,

Herniation of the urinary bladder is rare and most cases are asymptomatic. They are incidentally noted during imaging or during the course of surgical repair. Though rare, compilations like acute renal failure, rupture, infection and calculus formation can occur. We report a case of vesicoinguinal hernia, detected incidentally on the whole body fluoro-deoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) study.

A 65-year-old man who presented with cervical lymph nodal enlargement was subjected to excision biopsy. Histopathology revealed metastases from poorly differentiated carcinoma. He was referred for a whole body FDG PET-CT study. PET scan [Figure 1] showed elevated FDG uptake in the surgical site. A suspicious soft-tissue nodule was noted near the deep lobe of left parotid gland. Incidentally, there was herniation of the urinary bladder into the right inguinal canal (a) urinary bladder herniation was clearly depicted in the coronal CT (b) and fused PET-CT (c) and the sagittal CT (d) and fused PET-CT (e) images.

Variety of incidental findings have been reported on FDG PET-CT studies. About 1-4% of all inguinal hernias involve the urinary bladder. [1] In aretrospective study of 662 patients with inguinal hernianly 2 patients had vesicoinguinal hernia. [2] Most cases are asymptomatic and are usually found incidentally on radiographic imaging or at the time of herniorrhaphy. Less than 7% of bladder hernias are diagnosed pre-operatively. [3] Only three cases of the urinary bladder herniation detected on FDGPET-CT have been previously reported. [4],[5],[6] Other incidental findings such as rupture [7] and vesico-colic fistula [8],[9] have also been described in FDG PET studies.
Figure 1: F-18 fluoro-deoxy glucose positron emission tomography (PET) scan (a) MIP (maximum intensity projection) image, (b) coronal computed tomography (CT), (c) coronal fused PET/CT (d) sagittal CT and (e) fused sagittal PET/CT images showing herniation of the urinary bladder into the right inguinal canal

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   References Top

1.Fisher PC, Hollenbeck BK, Montgomery JS, Underwood W 3 rd . Inguinal bladder hernia masking bowel ischemia. Urology 2004;63:175-6.  Back to cited text no. 1
    
2.Machado NO, Machado NN. Unusual contents of inguinal hernia sac. An approach to management. Surg Sci 2011;2:322-5.  Back to cited text no. 2
    
3.Kraft KH, Sweeney S, Fink AS, Ritenour CW, Issa MM. Inguinoscrotal bladder hernias: Report of a series and review of the literature. Can Urol Assoc J 2008;2:619-23.  Back to cited text no. 3
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4.Wienbeck S, Rahbar K, Birkfellner T, Weckesser M, Juergens KU. Inguino-scrotal herniation of urinary bladder diverticulum in a patient with pancreatic carcinoma : A potential pit fall in whole-body 18F-FDGPET-CT. Nuklearmedizin 2008;47:N34-6.  Back to cited text no. 4
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5.Hinojosa D, Joseph UA, Wan DQ, Barron BJ. Inguinal herniation of a bladder diverticulum on PET/CT and associated complications. Clin Imaging 2008;32:483-6.  Back to cited text no. 5
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6.Durán Barquero C, Serrano Vicente J, García Bernardo L, Domínguez Grande ML, Rayo Madrid JI, Infantedela Torre J R, et al. Inguinal herniation of a bladder diverticulum, diagnosed by PET-CT. Rev Esp Med Nucl 2010;29:36-7.  Back to cited text no. 6
    
7.Wosnitzer B, Mirtcheva R. Extraperitoneal urinary bladder perforation detected by FDG PET/CT. J Radiol Case Rep 2011;5:32-40.  Back to cited text no. 7
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8.Kao PF, Weng JH, Tseng HC, Lee JK. Diuresis makes vesico colic fistula visible on FDG PET/CT. Clin Nucl Med 2011;36:49-51.  Back to cited text no. 8
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9.Chen KY, Hsu CH, Kao CH, Hung GU, Chiu JS, Ho KW. Colovesical fistula in a patient with recurrent cervical cancer detected by FDG PET/CT. Clin Nucl Med 2010;35:808-10.  Back to cited text no. 9
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