Inguinal Bladder Herniation in 99Tcm-MDP SPECT/CT: Mimicking Prostate Cancer Bone Metastasis

Xinyu Zeng; Qiuju Huang; Chun Qing; Jun Dang

doi:10.25259/IJNM_12_2026

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doi:

10.25259/IJNM_12_2026

Inguinal Bladder Herniation in ⁹⁹Tcm-MDP SPECT/CT: Mimicking Prostate Cancer Bone Metastasis

Xinyu Zeng¹, Qiuju Huang¹, Chun Qing¹, Jun Dang^1,

1Department of Nuclear Medicine, 363 Hospital, Chengdu, China

*Corresponding author: Jun Dang, Department of Nuclear Medicine, 363 Hospital, Chengdu, China. dangjun0913@163.com

Received: 2026-01-14, Accepted: 2026-03-16, Epub ahead of print: 2026-06-10,

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This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Zeng X, Huang Q, Qing C, Dang J. Inguinal Bladder Herniation in ⁹⁹Tcm-MDP SPECT/CT: Mimicking Prostate Cancer Bone Metastasis. Indian J Nucl Med. doi: 10.25259/IJNM_12_2026

Abstract

An 89-year-old male with newly diagnosed prostate cancer underwent routine bone single photon emission computed tomography (SPECT) imaging. The scan revealed increased technetium-99m methylene diphosphonate (⁹⁹Tcm-MDP) uptake in the anterior segment of the left 9th rib, the 8th thoracic vertebra, and the right pubic region, raising suspicion of widespread osseous metastases. Previous chest computed tomography (CT) showed definite fractures of the left 9th rib and 8th thoracic vertebrae, so we suspected that the MDP concentration in the right pubic region might be due to other causes as well. Subsequent SPECT/CT fusion imaging diagnosed the MDP-concentrating foci at this site as an inguinal bladder hernia.

Keywords

Computed tomography

Inguinal bladder hernia

Single photon emission computed tomography

Technetium-99m methylene diphosphonate

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Bone scintigraphy showed significant radiotracer uptake in the anterior segment of the left 9th rib, the 8th thoracic vertebra, and the right pubic region, suggesting the possibility of widespread bone metastases [Fig 1]. However, the patient’s previous chest CT indicated fractures in the anterior segment of the left 9th rib and the 8th thoracic vertebra, so we suspect that the radiotracer uptake in the right pubic region may not be caused by bone metastases.

(a) The anterior whole-body image shows uptake of 99TcmMDP in the anterior segment of the left 9th rib (blue arrow) and the right pubic region (red arrow); (b) The posterior whole-body image shows uptake of 99Tcm-MDP in the 8th thoracic vertebra (black arrow). This suggests the possibility of multiple bone metastases. MDP: Technetium-99m methylene diphosphonate

Subsequent SPECT/CT fusion imaging localised the focal accumulation of radiotracer in the right pubic region to the aggregation of ⁹⁹Tcm-MDP within the scrotal bladder hernia sac. CT images demonstrated that the hernia extended medially into the scrotum through the inguinal canal, which was consistent with the manifestations of inguinal bladder hernia [Fig 2].

(a) Coronal image; (b) sagittal image; (c) Transverse image in SPECT/CT fusion imaging show 99Tcm-MDP accumulation in the right pubic area, which is a scrotal cystocele. The hernia is seen extending through the inguinal canal into the scrotum medially on CT images, findings consistent with inguinal bladder herniation. SPECT/CT: Single photon emission computed tomography/computed tomography; MDP: Technetium-99m methylene diphosphonate

Bladder herniation occurs when vesical tissue protrudes through normal or weakened anatomical structures, representing ≤4% of all inguinal hernias.^[1] Most cases are asymptomatic and incidentally detected during imaging or surgery.^[2] While SPECT exhibits high sensitivity for bone metastases, its limited specificity often necessitates complementary CT.^[3] This case highlights how inguinal bladder herniation may mimic pelvic metastasis on SPECT, emphasising the need for nuclear medicine physicians to consider this pitfall and utilise SPECT/CT when indicated.

Author contributions:

XZ: Conceptualisation, methodology, writing – original draft; QH: Validation, visualisation; CQ: Resources, software; JD: Supervision, project administration, writing – review and editing. All authors read and approved the final manuscript.

Ethical approval:

Institutional Review Board approval is not required.

Declaration of patient consent:

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given consent for their images and other clinical information to be reported in the journal. The patient understand that the patient’s names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Conflicts of interest:

There are no conflicts of interest.

Use of artificial intelligence (AI)-assisted technology for manuscript preparation:

The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.

Financial support and sponsorship: Nil.

References

Lee JY, Oh SY, Chang IH, Choe JW, Park SH, Ryu JH, et al. Laparoscopic repair of large bladder herniation presenting as an inguinal hernia. Korean J Urol. 2013;54:139-42.
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[CrossRef] [PubMed] [Google Scholar]
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[1] Lee JY, Oh SY, Chang IH, Choe JW, Park SH, Ryu JH, et al. Laparoscopic repair of large bladder herniation presenting as an inguinal hernia. Korean J Urol. 2013;54:139-42.
[CrossRef] [PubMed] [Google Scholar]

[2] Ji T, Gao D, Chen B, Wang R, Gao S. 99mTc-MDP uptake in SPECT/CT by a bladder hernia simulating inguinal metastasis: A case report. Oncol Lett. 2016;11:1398-1400.
[CrossRef] [PubMed] [Google Scholar]

[3] Savelli G, Maffioli L, Maccauro M, De Deckere E, Bombardieri E. Bone scintigraphy and the added value of SPECT (single photon emission tomography) in detecting skeletal lesions. Q J Nucl Med. 2001;45:27-37.
[Google Scholar]