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AJNR - American Journal of Neuroradiology

Published ahead of print on February 12, 2009
doi: 10.3174/ajnr.A1469

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American Journal of Neuroradiology 30:1270-1272, June-July 2009
© 2009 American Society of Neuroradiology

Case Report
BRAIN

Retained Surgical Sponges after Craniotomies: Imaging Appearances and Complications

A.K. Kim^a, E.B. Lee^b, L.J. Bagley^a and L.A. Loevner^a

^a Department of Neuroradiology, University of Pennsylvania, Philadelphia, Pa
^b Department of Pathology, University of Pennsylvania, Philadelphia, Pa

Please address correspondence to Laurie A. Loevner, MD, Department of Neuroradiology, University of Pennsylvania Health System, 3400 Spruce St, 2 Dullas Bldg, Philadelphia, PA 19104; e-mail: laurie.loevner{at}uphs.upenn.edu

SUMMARY: Imaging within 24 to 48 hours after most neurosurgical procedures is a routine practice. Nonresorbable surgical sponges have radiopaque filaments readily visible on CT scans and plain film radiographs. However, the proton-poor barium sulfate responsible for this radio-opacity is generally not detectable on MR imaging in the immediate post-operative period. Findings on MR imaging become more evident with elapsing time and when a foreign-body reaction to the sponge manifests as a mass lesion, which can mimic residual or recurrent intracranial tumor or abscess. Although preventive measures by our surgical colleagues to ensure accurate and correct sponge counts before and after wound closure is paramount, even the most fastidious efforts may rarely result in an inadvertently retained surgical sponge. The role of the radiologist is to recognize the imaging findings of this entity and its potential complications so that appropriate and prompt management can be initiated.