Herniated Urinary Bladder Detected on 18F-Fluorodeoxyglucose Positron-Emission Tomography/Computed Tomography Scan Imitating as 18F-Fluorodeoxyglucose Avid Lesion.

Inguinal hernia is a common pathology seen in the general population. However, the presence of herniated urinary bladder in the inguinal canal is a rare condition. Most cases are asymptomatic and are detected incidentally either during surgery or on imaging. Here, we present a report, where a patient, diagnosed case of carcinoma esophagus, was referred for staging 18F-fluorodeoxyglucose positron-emission tomography/computed tomography (FDG PET/CT) scan and revealed FDG uptake in the right inguinal canal, other than primary and metastatic lesions and corresponding CT and fused PET/CT images revealed herniated urinary bladder in the inguinal canal. Copyright:

A 55-year-old male patient, recently diagnosed case of carcinoma esophagus, was referred for staging 18F-fluorodeoxyglucose positron-emission tomography/computed tomography (FDG PET/CT) scan. MIP image [Figure 1a] showed few foci of FDG uptake in whole body. FDG-avid primary lesion [Figure 1b–d] was localized in the distal esophagus and FDG-avid metastatic lesions were appreciated in the right lung and liver. Apart from these, a large lobulated FDG-avid focus was visualized in the right inguinal region. On correlating with corresponding CT and fused PET/CT axial and sagittal views [Figure 1e–j], the FDG avid focus in the right inguinal region was found to be of fluid density on CT, continuous with the urinary bladder, thus confirming the FDG uptake as the herniated urinary bladder in the right inguinal canal.

Figure 1

Maximum intensity projection (a) of whole-body 18F-fluorodeoxyglucose positron-emission tomography/computed tomography scan showing 18F-fluorodeoxyglucose uptake in the right inguinal canal in addition to 18F-fluorodeoxyglucose-avid lesions in primary and metastatic sites. Axial fused positron-emission tomography/computed tomography (b), computed tomography (c), and positron-emission tomography (d) images showing 18F-fluorodeoxyglucose-avid lesion in distal esophagus, corresponding to the known primary site. 18F-fluorodeoxyglucose uptake in the right inguinal canal (g and j) localises to herniated urinary bladder as seen in fused positron-emission tomography/computed tomography axial (e) sagittal (h) and computed tomography axial (f) and sagittal (i) images

Bladder hernia represents 0.5%–3% of all lower abdominal hernias[1] and 1%–3% of cases of all inguinal hernias[2] and is observed in obese men between the ages of 50 and 70 years. Most of these hernias are direct and seen in the right side[3] as seen in our case. The possible reasons of bladder hernias are bladder neck obstruction due to prostatic hypertrophy, reduced bladder tone, weak pelvic muscles, and obesity.[4] Most cases are asymptomatic and are detected incidentally. Less than 7% of bladder hernias are diagnosed preoperatively.[5]

In normal individuals, intense FDG uptake is observed in the kidneys, ureters, and bladders because of normal urinary excretion. The differential diagnosis of FDG uptake in the inguinal canal includes testicular cancer, inflammation and urine skin contamination artifact, metastatic lymph nodes, hernia with bowel loops as contents, and inguinal herniation of the urinary bladder. Few reports have been published previously of incidentally detected herniated urinary bladder on CT[6] and on PET/CT scan[78910].

Here, we report an interesting case of a rare finding of incidentally detected herniated urinary bladder and also highlight the importance of keeping differentials in mind of FDG uptake in the inguinal canal and correlating axial, coronal, and sagittal images and PET image with fused PET/CT and CT images.

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The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.