PDF(Pubmed)
Abstract：
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.
摘要：
血管内治疗后的异物肉芽肿是罕见的并发症，主要在脑或皮肤血管组织中报道。据我们所知,迄今为止,尚无研究报道将N-丁基-2-氰基丙烯酸酯(NBCA)-碘油混合物注入腹部动脉后发生腹部异物肉芽肿.这项研究报告了一例异物肉芽肿，在使用NBCA-碘油混合物栓塞右髂内动脉瘤12个月后出现，这对区分恶性肿瘤提出了挑战。我们介绍了一名77岁的男子，他接受了右髂内动脉瘤的栓塞和腹主动脉瘤的开放手术修复。术后12个月进行的对比增强CT检查显示右侧腹膜后肿块围绕髂腰肌。质量包含多个，小,高密度区域，提示NBCA-碘油混合物从栓塞的右髂内动脉瘤转移。鉴别诊断包括异物肉芽肿，淋巴瘤和肉瘤.病变的活检显示肉芽肿具有不同的炎症阶段，没有铁血黄素沉积,多核巨细胞,和含有脂肪的泡沫细胞，被诊断出异物肉芽肿.对微生物的特殊染色未发现提示感染的发现。因为病人没有症状,未进行治疗。术后24个月的CT造影显示肿块缩小，术后48个月未发现大小变化。本报告重点介绍了一种模仿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导致肉芽肿形成。放射科医师应考虑使用NBCA栓塞到腹部动脉后的异物肉芽肿。
