Suture granuloma

Last revised by Dawood Tafti on 30 Sep 2021

Suture granulomas are localized inflammatory reactions in response to retained suture material. A similar process may also occur in certain situations with mesh repairs 5. Ultrasound is often used as a first-line imaging modality. It may be confused with a tumor or a recurrent tumor after surgery and should be considered in the differential in the correct setting.

Usually develops slowly after an intervention. It may become a palpable and tender mass, mimicking tumor or recurrent tumor.

A suture granuloma represents a benign granulomatous proliferation in response to a retained foreign body. They less commonly occur with absorbable sutures, but may still occur.

Obtaining a history of prior surgery with a surgical approach around the area of concern is important. Suture granulomas can present in the neck after thyroidectomy, mimicking recurrence 4.

High-frequency (>10 MHz) linear probe is useful.

  • hypoechoic collection
  • a small hyperechoic structure in the collection (the suture) is highly specific
    • often has parallel hyperechoic 'rail-like' morphology
  • may show mild vascularity on color Doppler 
  • may be FDG avid, mimicking neoplasm 2,3

The treatment of choice is resection of the retained suture and surrounding inflammatory tissue.

General imaging differential considerations include

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Cases and figures

  • Figure 1: suture granuloma (crossed polarizers)
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  • Case 1: periumbilical
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  • Case 1: periumbilical
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  • Case 2: appendectomy scar
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