Inguinal Hernia Containing the Bladder and Postoperative Appearance: A Multimodality Case Report

A 79-year-old man with prostate cancer underwent initial staging prior to prostatectomy with 99mTc-methylene diphosphonate (99mTc-MDP) bone scintigraphy. Anterior and pos-terior images showed focal uptake overlying the pubic symphysis. Lateral views showed that the activity was extraosseous. Follow-up CT urography showed a bladder hernia as cause of the abnormality on bone scan. Prostatectomy and inguinal hernia repair were performed as a combination case. Four years postoperatively, follow-up ⁶⁸Ga-PSMA-11 positron emission tomography/computed tomography (PET/CT) showed no recurrence. The CT component of the exam show an intermediate density focus at the right inguinal hernia repair site, corresponding to a polypropylene mesh plug, and a hyperattenuating Gore-Tex mesh repair of the left inguinal hernia. This case highlights the importance of lateral projections in resolving scintigraphic pitfalls and recognizing mesh-related im-aging appearances to prevent misinterpretation.