Fumimoto Masaya, Kohno Shigeshi, Oka Shojiro, Someya Yuko, Ishikura Reiichi, Nakamura Ken, Yamashita Daisuke, Ueda Hiroyuki, Ando Kumiko
Diagnostic Radiology, Kobe City Medical Center General Hospital, Kobe, JPN.
Cardiovascular Surgery, Kobe City Medical Center General Hospital, Kobe, JPN.
Cureus. 2024 May 13;16(5):e60187. doi: 10.7759/cureus.60187. eCollection 2024 May.
Foreign body granulomas following endovascular treatment are rare complications and are mostly reported in the brain or cutaneous vascular tissues. To the best of our knowledge, no study to date has reported on foreign body granulomas in the abdomen after injection of N-butyl-2-cyanoacrylate (NBCA)-lipiodol mixture into the abdominal arteries. This study reports a case of foreign body granuloma that appeared 12 months after the embolization of a right internal iliac artery aneurysm using an NBCA-lipiodol mixture, which posed challenges in differentiation from malignant tumors. We present a 77-year-old man who underwent embolization of a right internal iliac artery aneurysm and open surgical repair of an abdominal aortic aneurysm. A contrast-enhanced CT performed 12 months postoperatively revealed a right-sided retroperitoneal mass surrounding the iliopsoas muscle. The mass contained multiple, small, hyperdense areas, suggesting the migration of the NBCA-lipiodol mixture casts from the embolized right internal iliac artery aneurysm. The differential diagnosis included foreign body granuloma, lymphoma, and sarcoma. A biopsy of the lesion revealed a granuloma with various stages of inflammation, no hemosiderin deposition, multinucleated giant cells, and foam cells containing fat, and was diagnosed with a foreign body granuloma. Special staining for microorganisms revealed no findings suggestive of infection. Because the patient was asymptomatic, no treatment was administered. Contrast-enhanced CT at 24 months postoperatively showed shrinkage of the mass, with no change in size noted at 48 months postoperatively. This report highlights a foreign body granuloma that mimicked malignant tumors. Extravascular migration of the NBCA-lipiodol mixture casts likely contributed to granuloma formation. Radiologists should consider foreign body granulomas after embolization using NBCA into the abdominal arteries.
血管内治疗后发生的异物肉芽肿是罕见的并发症，大多报道于脑部或皮肤血管组织。据我们所知，迄今为止尚无研究报道在腹部动脉注射N-丁基-2-氰基丙烯酸酯（NBCA）-碘油混合物后发生腹部异物肉芽肿。本研究报告了1例使用NBCA-碘油混合物栓塞右侧髂内动脉瘤12个月后出现异物肉芽肿的病例，该病例在与恶性肿瘤的鉴别诊断方面存在挑战。我们介绍了1例77岁男性患者，其接受了右侧髂内动脉瘤栓塞术及腹主动脉瘤开放手术修复。术后12个月进行的增强CT显示右侧腹膜后肿块包绕髂腰肌。肿块内有多个小的高密度区，提示NBCA-碘油混合物铸型从栓塞的右侧髂内动脉瘤处迁移。鉴别诊断包括异物肉芽肿、淋巴瘤和肉瘤。病变活检显示为具有不同炎症阶段的肉芽肿，无含铁血黄素沉积、多核巨细胞，以及含脂肪的泡沫细胞，诊断为异物肉芽肿。微生物特殊染色未发现提示感染的结果。由于患者无症状，未给予治疗。术后24个月的增强CT显示肿块缩小，术后48个月大小无变化。本报告强调了1例酷似恶性肿瘤的异物肉芽肿。NBCA-碘油混合物铸型的血管外迁移可能促成了肉芽肿的形成。放射科医生在使用NBCA对腹部动脉进行栓塞后应考虑到异物肉芽肿。
