alexa The Appearance of Hemostatic Fleece on Different Imaging Modalities: A Case Report
ISSN: 2165-7920

Journal of Clinical Case Reports
Open Access

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Case Report

The Appearance of Hemostatic Fleece on Different Imaging Modalities: A Case Report

Jakob Graves Rønk Dinesen*, Katrine Fuglsang, Gitte Ørtoft Lykkegaard, Lone Kjeld Petersen and Margit Dueholm
Aarhus Universitets Hospital, Denmark
*Corresponding Author : Jakob Graves Rønk Dinesen
Aarhus Universitets hospital
Denmark
Tel: +45 7845 0000
E-mail: [email protected]
Received December 23, 2015; Accepted February 17, 2016; Published February 22, 2016
Citation: Dinesen JGR, Fuglsang K, Lykkegaard GØ, Petersen LK, Dueholm M (2016) The Appearance of Hemostatic Fleece on Different Imaging Modalities: A Case Report. J Clin Case Rep 6:711. doi:10.4172/2165-7920.1000711
Copyright: © 2016 Dinesen JGR, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
 

Abstract

We report a case where hemostatic fleece (TachoSil) was misinterpreted as residual disease on imaging after macro-radical surgery for ovarian cancer. Laparotomy was performed on a 51 year-old woman due to ovariancancer. At surgery, carcinomatosis was identified on the diaphragm with growth intothe diaphragmatic muscle. Total hysterectomy, bilateral salpingooophorectomy, omentectomy, pelvic and paraaortic lymphadenectomy, diaphragmatic peritonectomy, appendectomy and resection of sigmoid colon were performed. During surgery an incidental small liver lesion occurred and hemostatic fleece was applied for hemostasis. Total cytoreduction was achieved. The pathology report demonstrated stage IV serous ovarian cancer (grade III). The patient was therefore referred to the Department of oncology for six series of Paclitaxel/Carboplatin. A baseline CT scan revealed an area above the liver initially described as residual disease. At the multidisciplinary conference the CT scan was revised and compared with the surgical report and it was concluded that the suspected area concurred with the hemostatic fleece applied during surgery and not a sign of residual disease. After two months of adjuvant chemotherapy, a follow up CT scan revealed almost total regression and after six months, a MRI demonstrated almost no signs of the hemostatic fleece or recurrent disease. The patient is still disease free after18 months. Application of a hemostatic fleece may initiate inflammatory changes causing imaging artifacts. We, therefore, emphasize the importance of reporting in the operation note the specific location of hemostatic fleece applied during surgery to avoid hemostatic fleece being misinterpreted as residual disease on imaging.

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