Incarcerated inguinal hernia from metastatic pleural mesothelioma: PET/CT imaging

Our plain-English summary of Incarcerated inguinal hernia from metastatic pleural mesothelioma: PET/CT imaging, by V.X. Nguyen, B.D. Nguyen, P.C. Ram, et al (Clinical Nuclear Medicine, 2012).

The study

• Authors: V.X. Nguyen, B.D. Nguyen, P.C. Ram, M.C. Roarke
• Journal: Clinical Nuclear Medicine
• Published: 2012;37(5):e117-8
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

PET/CT provides a comprehensive staging, post-therapeutic surveillance, and outcome prognosis of malignant pleural mesothelioma based on its hypermetabolic behavior. This ability of PET may allow the monitoring, prediction, and detection of uncommon distant gastrointestinal clinical manifestations of this disease. The authors present a case of PET/CT imaging of pleural mesothelioma disseminating to the abdomen and pelvis, inducing an incarcerated inguinal hernia.

In plain English

This short image-based case report, from the radiology department of Mayo Clinic in Scottsdale, Arizona, described one 60-year-old man with unresectable right-sided malignant epithelioid pleural mesothelioma. He had been treated with chemotherapy and then stopped all therapies for 2 years. When he returned with breathlessness, trouble swallowing, chest pain and worsening cough, PET/CT scanning showed the chest tumor had progressed, including spread through the right diaphragm. The scan also showed hypermetabolic uptake in the right inguinal (groin) canal suspicious for tumor. He had had a groin hernia repaired with mesh 7 years earlier and had noticed a groin bulge for 7 months. Five days after the scan he was admitted with an incarcerated (trapped) hernia. Surgery found tumor in the hernia sac matching the pleural mesothelioma. The authors concluded that PET/CT staged his advanced disease and showed distant groin spread that caused the incarceration. The article did not report whether this patient had been exposed to asbestos.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (an 'Interesting Image' report of a single patient)
• Who was studied: One 60-year-old man with unresectable right-sided malignant epithelioid pleural mesothelioma, previously treated with chemotherapy, who then stopped all therapies for 2 years. The authors were from the Department of Radiology, Mayo Clinic, Scottsdale, Arizona, and the patient was admitted to their institution.
• Main results:
  • PET/CT in this patient, compared with an examination 2 years earlier, showed progression of the right-sided pleural mesothelioma. Findings included near-total invasion of the right chest, tumor in the mediastinum, new left pleural lesions, and tumor passing through the right diaphragm.
  • PET/CT also showed hypermetabolic uptake at the right inguinal canal suspicious for tumor infiltration.
  • The patient had had an inguinal hernia mesh repair 7 years earlier. He reported a 7-month history of a reducible, symptom-free bulge in the right groin.
  • Five days after the PET/CT, the patient was admitted to emergency services with an irreducible, markedly tender right groin mass consistent with an incarcerated hernia.
  • Surgical repair, with removal of part of the hernia sac, confirmed infiltrating tumor whose histology matched the pleural mesothelioma.
• The authors' conclusion: The authors concluded that in this case PET/CT provided comprehensive staging of the patient's advanced pleural mesothelioma. They wrote that its hypermetabolic features showed a distant right groin metastasis that caused the later hernia incarceration.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Inguinal Hernia, Pleural Mesothelioma, Staging, Prognosis.

Related studies

• Peritoneal mesothelioma masquerading as an inguinal hernia — S. Chakravartty, J.C. Singh, et al. (2011)
• Peritoneal mesothelioma masquerading as an inguinal hernia — S. Chakravartty, J.C. Singh, et al. (2012)
• Fine-needle aspiration of a well-differentiated papillary mesothelioma in the inguinal hernia sac: A case report and review of literature — Y.Y. Wheeler, F. Burroughs, et al. (2009)
• Current evidence base of FDG-PET/CT imaging in the clinical management of malignant pleural mesothelioma: emerging significance of image segmentation and global disease assessment — S. Basu, B. Saboury, et al. (2011)
• Multimodality imaging of common and uncommon peritoneal diseases: a review for radiologists — R.A. Vicens, M. Patnana, et al. (2015)
• 18F-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography fused imaging in malignant mesothelioma patients: looking from outside is not enough — E. Roca, S. Laroumagne, et al. (2013)

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