Purpose: Our goal was to demonstrate possible pitfalls in the CT diagnosis of retained surgical sponges (textilomas) and to evaluate the impact of gas bubbles inside a textiloma.
Method: Thirteen patients with textilomas were investigated with CT 3 weeks to 8 years after surgery. Twelve of the 13 textilomas were removed within 3 weeks after the first CT examination. Eight samples of surgical sponges were placed in a water bath for 6 months. Serial CT was performed to document the presence and persistence of gas bubbles.
Results: The radiopaque marker inside the textiloma was seen in nine patients but did not lead to the diagnosis in all patients. In seven patients gas bubbles were found inside the textiloma with a typical pattern. None of these patients had an abscess formation. In vitro studies demonstrated gas bubbles in all surgical sponges scanned 1 h afterward. The number of gas bubbles was not significantly reduced after 6 months.
Conclusion: The variable appearance of retained surgical sponges can lead to diagnostic misinterpretations. If present, typical spongiform pattern with gas bubbles is the most specific sign for the detection of textilomas but does not indicate an abscess formation.