Surgicel-Related Uptake on Positron Emission Tomography Scan Mimicking Prosthetic Valve Endocarditis

Martínez, Amparo; Pubul, Virgina; Jokh, Estephany Abou; Martínez, A.J. Gonzalez; El-Diasty, Mohamed; Fernández, Ángel L.

doi:10.1016/j.athoracsur.2021.02.046

Cited by 3 publications

(4 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…2019;127(12):765-70, and Arch Bronconeumol. 2020;56 (7):459-71], the station 7 acellular, amorphous, and hyaline-like exogenous material found in our case was interpreted as hemostatic agent compatible with Surgicel® (or oxidized regenerated cellulose). This case highlights the importance of cytologic/histologic recognition of hemostatic agents, specifically oxidized cellulose mesh.…”

mentioning

confidence: 65%

“…A granulomatous reaction to oxidized cellulose mesh may mimic tumor recurrence, hematoma, or abscess on imaging [1,6]. Surgicel ® has been reported to cause avidity uptake on F-FDG positron emission tomography/CT, which can last up to 12 months after lung surgery and 2-6 months after abdominal surgery [7]. In summary, there are no specific imaging features for Surgicel ® [3].…”

Section: Discussion/conclusionmentioning

confidence: 99%

See 1 more Smart Citation

Oxidized Regenerated Cellulose (Surgicel®) on Cytology/Histology

et al. 2022

View full text Add to dashboard Cite

Introduction: In patients with a history of malignancy, follow-up surveillance of lymph nodes (LNs) is required to evaluate for potential malignancy or infection. In some cases, the lymphadenopathy may be secondary to an intraprocedural hemostatic agent and/or related granulomatous reaction. Case Presentation: We present the case of an 80-year-old female with a remote past medical history of breast cancer status post-lumpectomy and chemoradiation. Twenty years later, a 2.4 cm pulmonary right middle lobe nodule was noted on imaging studies. She underwent bronchoscopy, cervical mediastinoscopy, and right middle lobe wedge resection. The final pathologic diagnosis was a pulmonary carcinoid tumor, and the excised mediastinal LN was negative for malignancy. A 10-month surveillance positron emission tomography scan showed new mildly avid mediastinal and right hilar LNs. The following endobronchial ultrasound-guided transbronchial needle aspiration showed unremarkable lymphoid elements in the enlarged 4R LN, while the station 7 LN demonstrated ample dense hyaline-like foreign material. Subsequent review of the cell block/biopsy and communication with the thoracic surgeon revealed that Surgicel® (or oxidized regenerated cellulose) was placed during surgery at the station 7 site. Discussion/Conclusion: Assessment of the findings and based on the similar histologic appearance reported in previous cases associated with Surgicel® [Ann Thorac Med. 2017;12(1):55–6, Cancer Cytopathol. 2019;127(12):765–70, and Arch Bronconeumol. 2020;56(7):459–71], the station 7 acellular, amorphous, and hyaline-like exogenous material found in our case was interpreted as hemostatic agent compatible with Surgicel® (or oxidized regenerated cellulose). This case highlights the importance of cytologic/histologic recognition of hemostatic agents, specifically oxidized cellulose mesh.

show abstract

mentioning

confidence: 65%

Section: Discussion/conclusionmentioning

confidence: 99%

Oxidized Regenerated Cellulose (Surgicel®) on Cytology/Histology

et al. 2022

View full text Add to dashboard Cite

show abstract

“…In thoracic surgery practice, it is used more frequently to control oozing like hemorrhages at mediastinal lymph node dissection regions and it is generally left in place. Although it is absorbable, it has been shown that excessive use of OC may lead to various complications in the early postoperative period and may require repeat surgery [9,10].Foreign body reaction due to OC may also mimic infection [11].…”

Section: Discussionmentioning

confidence: 99%

“…9,10 Foreign body reaction due to OC may also mimic infection. 11 However, in the long term, OC causing foreign body reaction that mimics malignant mediastinal lymphadenopathy (LAP) is a more common complication. This occurs when peroperatively placed OC creates a foreign body reaction during follow-up that imitates a mediastinal LAP with increased SUVMax.…”

Section: Discussionmentioning

confidence: 99%

Foreign Body Reaction Mimicking Lymph Node Metastasis is Not Rare After Lung Cancer Resection

Cimenoglu,

Dogruyol,

Ozdemir

et al. 2023

Thorac Cardiovasc Surg

View full text Add to dashboard Cite

Background Mediastinal lymphadenopathies with high 18-fluorodeoxyglucose uptake in patients previously operated on for lung cancer are alarming for recurrence and necessitate invasive diagnostic procedures. Peroperative placement of oxidized cellulose to control minor bleeding may lead to a metastasis-like image through a foreign body reaction within the dissected mediastinal lymph node field at postoperative examinations. In this study, we investigated clinicopathological features and the frequency of foreign body reaction mimicking mediastinal lymph node metastasis. Methods Patients who underwent surgery for lung cancer between January 2016 and August 2021 and who were subsequently evaluated for mediastinal recurrence with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) were included. Patients were grouped according to the results of EBUS-TBNA as metastasis, foreign body, and reactive. Clinicopathological features of these patients were compared and characteristics of patients in the foreign body group were scrutinized. Results EBUS-TBNA was performed on a total of 34 patients during their postoperative follow-up due to suspicion of mediastinal recurrence. EBUS-TBNA pathological workup revealed metastasis in 18 (52.9%), foreign body reaction in 10 (29.4%) and reactive lymph nodes in 6 (17.6%) patients. Mean maximum standardized uptake value (SUVMax) for metastasis group and foreign body group were 9.39 ± 4.69 and 5.48 ± 2.54, respectively (p = 0.022). Time interval between the operation and EBUS-TBNA for the metastasis group was 23.72 ± 10.48 months, while it was 14.90 ± 12.51 months in the foreign body group (p = 0.015). Conclusion Foreign body reaction mimicking mediastinal lymph node metastasis is not uncommon. Iatrogenic cause of mediastinal lymphadenopathy is related to earlier presentation and lower SUVMax compared with metastatic lymphadenopathy.

show abstract

Clinical presentation, microbiology, and prognostic factors of prosthetic valve endocarditis. Lessons learned from a large prospective registry

Ramos-Martínez,

Domínguez,

Muñoz

et al. 2023

PLoS ONE

View full text Add to dashboard Cite

Background Prosthetic valve endocarditis (PVE) is a serious infection associated with high mortality that often requires surgical treatment. Methods Study on clinical characteristics and prognosis of a large contemporary prospective cohort of prosthetic valve endocarditis (PVE) that included patients diagnosed between January 2008 and December 2020. Univariate and multivariate analysis of factors associated with in-hospital mortality was performed. Results The study included 1354 cases of PVE. The median age was 71 years with an interquartile range of 62–77 years and 66.9% of the cases were male. Patients diagnosed during the first year after valve implantation (early onset) were characterized by a higher proportion of cases due to coagulase-negative staphylococci and Candida and more perivalvular complications than patients detected after the first year (late onset). In-hospital mortality of PVE in this series was 32.6%; specifically, it was 35.4% in the period 2008–2013 and 29.9% in 2014–2020 (p = 0.031). Variables associated with in-hospital mortality were: Age-adjusted Charlson comorbidity index (OR: 1.15, 95% CI: 1.08–1.23), intracardiac abscess (OR:1.78, 95% CI:1.30–2.44), acute heart failure related to PVE (OR: 3. 11, 95% CI: 2.31–4.19), acute renal failure (OR: 3.11, 95% CI:1.14–2.09), septic shock (OR: 5.56, 95% CI:3.55–8.71), persistent bacteremia (OR: 1.85, 95% CI: 1.21–2.83) and surgery indicated but not performed (OR: 2.08, 95% CI: 1.49–2.89). In-hospital mortality in patients with surgical indication according to guidelines was 31.3% in operated patients and 51.3% in non-operated patients (p<0.001). In the latter group, there were more cases of advanced age, comorbidity, hospital acquired PVE, PVE due to Staphylococcus aureus, septic shock, and stroke. Conclusions Not performing cardiac surgery in patients with PVE and surgical indication, according to guidelines, has a significant negative effect on in-hospital mortality. Strategies to better discriminate patients who can benefit most from surgery would be desirable.

show abstract

Surgicel-Related Uptake on Positron Emission Tomography Scan Mimicking Prosthetic Valve Endocarditis

Cited by 3 publications

References 6 publications

Oxidized Regenerated Cellulose (Surgicel®) on Cytology/Histology

Oxidized Regenerated Cellulose (Surgicel®) on Cytology/Histology

Foreign Body Reaction Mimicking Lymph Node Metastasis is Not Rare After Lung Cancer Resection

Clinical presentation, microbiology, and prognostic factors of prosthetic valve endocarditis. Lessons learned from a large prospective registry

Contact Info

Product

Resources

About