Multimodality imaging of Surgicel(®), an important mimic of post-operative complication in the thorax

Absorbable hemostatic agents such as Surgicel are hemostatic materials composed of an oxidized cellulose polymer used to control post-surgical bleeding and cause coagulation. This material is sometimes purposefully left in situ where it slowly degrades over time and can produce an imaging appearance that mimics serious post-operative complications such as gangrenous infections and anastomotic leaks as well as potentially mimicking disease recurrence in later stages. In this article, we review the multimodality imaging appearance of this material in situ longitudinally in the range of post-operative settings, in order to promote awareness of this entity when interpreting post-operative imaging. We present this as a pictorial review focusing primarily but not exclusively on the chest noting that the thoracic imaging appearance of Surgicel(®) is less well reported in the published literature. An understanding of this entity may help to minimize erroneous diagnosis of a postoperative complication leading to unnecessary interventions.