Inguino-scrotal bladder hernia: an unexpected finding on 68Ga-PSMA PET/CT

Document Type : Case report

Authors

1 Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

2 Nuclear Medicine & Molecular Imaging Department, Imam Reza International University, Mashhad, Iran

Abstract

Bladder herniation is an uncommon condition mimicking suspicious metastasis on PET/CT imaging. We report a 67 y/o man with prostate cancer referred for recurrence evaluation with 68Ga-PSMA-11 PET/CT. The scan showed an asymmetric site of intense tracer accumulation in the left inguino-scrotal region with the same SUVmax to the pelvic bladder. Reviewing cross sectional CT images with PET confirmed the inguino-scrotal bladder herniation.

Keywords


  1. Czarniecki M, Mena E, Lindenberg L, Cacko M, Harmon S, Radtke JP, et al. keeping up with the prostate-specific membrane antigens (PSMAs): an introduction to a new class of positron emission tomography (PET) imaging agents. Translational andrology and urology. 2018; 7(5):831-43.
  2.  Shetty D, Patel D, Le K, Bui C, Mansberg R. Pitfalls in Gallium-68 PSMA PET/CT Interpretation-A Pictorial Review. Tomography (Ann Arbor, Mich). 2018; 4(4):182-93.
  3. Dadgar H, Emami F, Norouzbeigi N, Vafaee MS, Jafari E, Gholamrezanezhad A, et al. Application of [68Ga] PSMA PET/CT in Diagnosis and Management of Prostate Cancer Patients. Molecular Imaging and Biology. 2019:1-8.
  4. Usmani S, Marafi F, Ahmed N, Kazem N. Inguinal Herniation of Urinary Bladder on F-18 Sodium Fluoride (NaF) PET-CT. Nucl Med Mol Imaging. 2017; 51(4):368-70.
  5. 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(11):767.
  6. Moufid K, Touiti D, Mohamed L. Inguinal bladder hernia: four case analyses. Rev Urol. 2013; 15(1):32-6.
  7. Park SH, Kim M-J, Kim JH, Cho AE-H, Park M-S, Kim KW. FDG Uptake in PET by Bladder Hernia Simulating Inguinal Metastasis. Yonsei Med J. 2007; 48(5):886-90.
  8. Vadi SK, Mittal BR, Singh H, Kumar R, Dhiman RK. Incidental Detection of Urinary Bladder Herniation in (18) F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Mimicking as Metastatic Deposit in the Inguinal Canal. Indian J Nucl Med. 2019; 34(3):247-8.
  9. Puranik AD, Purandare NC, Agrawal A, Shah S, Rangarajan V. Incidentally detected grade 3 cystocele on FDG PET/CT in a case of suspected malignancy. Indian journal of nuclear medicine: IJNM: the official journal of the Society of Nuclear Medicine, India. 2012; 27(4):264-5.
  10. Bujan-Lloret C, Garcia-Gomez FJ, de la Riva-Perez PA, Calvo-Moron MC, Castro-Montano J. Incidental diagnosis of bladder herniation by (18)F-FDG PET/CT. Rev Esp Med Nucl Imagen Mol. 2019;38(1):54.
  11. Hinojosa D, Joseph UA, Wan DQ, Barron BJ. Inguinal herniation of a bladder diverticulum on PET/CT and associated complications. Clin Imaging. 2008; 32(6):483-6.
  12. Kaneta T, Takanami K, Mitamura A, Hiraide T, Fukuda H, Yamada S, et al. FDG accumulation in obturator herniation of the bladder mimicking metastatic disease. Clin Nucl Med. 2009; 34(6):395-7.
  13. 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 pitfall in whole-body 18F-FDG PET-CT. Nuklearmedizin. 2008; 47(4):N34-6.
  14. Uprimny C, Kroiss AS, Decristoforo C, Fritz J, Warwitz B, Scarpa L, et al. Early dynamic imaging in (68) Ga- PSMA-11 PET/CT allows discrimination of urinary bladder activity and prostate cancer lesions. European journal of nuclear medicine and molecular imaging. 2017; 44(5):765-75.
  15. Barakat A, Yacoub B, Homsi ME, Saad Aldine A, El Hajj A, Haidar MB. Role of Early PET/CT Imaging with 68Ga-PSMA in Staging and Restaging of Prostate Cancer. Scientific reports. 2020; 10(1):2705.
  16. Schmuck S, Mamach M, Wilke F, von Klot CA, Henkenberens C, Thackeray JT, et al. Multiple Time-Point 68Ga-PSMA I&T PET/CT for Characterization of Primary Prostate Cancer: Value of Early Dynamic and Delayed Imaging. Clin Nucl Med. 2017; 42(6):e286-e93.
  17. Derlin T, Weiberg D, von Klot C, Wester HJ, Henkenberens C, Ross TL, et al. (68)Ga-PSMA I&T PET/CT for assessment of prostate cancer: evaluation of image quality after forced diuresis and delayed imaging. European radiology. 2016; 26(12):4345-53.