Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

19 Radiologic Evaluation for Postoperative Groin Pain
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Fig. 19.5. Coronal MR T1-weighted, axial T1- weighted, and axial fat-saturated
T2-weighted images of flat mesh material ( black arrows ) closing an
indirect defect of the right inguinal canal ( white arrow ). Flat mesh materials
typically appear as a thick hypointense line . While there is some undulation of
this mesh, there is no inappropriate folding and no significant mass effect to
suggest meshoma or mesh reaction.
Fig. 19.6. Contrast-enhanced axial CT and corresponding contrast enhanced
T1-weighted axial MR images of mesh plug within the left direct space. Both
modalities reveal a large “mass” ( white arrows ) with similar density/intensity as
soft tissue. This appearance is due to incorporation of soft tissue within the mesh
plug’s interstices. Though there is mild irregularity within the plug, the lack of
contrast enhancement and normal appearance of the surrounding fat confirms lack
of mesh pathology.
sequences are particularly capable of identifying such pathology, which
may be missed by CT.
Pain associated with more complex mesh materials such as plug or
sandwich designs are uniquely challenging to diagnose, as many radiologists
are not aware of the existence of such materials and may not be
able to recognize normal postoperative appearance without access to
detailed operative notes or direct communication by the referring physician.
Volume-occupying materials utilized in repair of large, patulous
defects often incorporate significant biological material into their interstices,
appearing on imaging as large pseudomasses and resulting in
misdiagnosis (Fig. 19.6 ). As an example, our own personal case series