Intensely FDG-avid Abdominal Wall Suture Granuloma at a Prior Transverse Rectus Abdominis Myocutaneous Donor Site Mimicking Metastasis in a Breast Cancer Patient

An 85-year-old woman with a history of left breast cancer underwent 18 F-FDG PET/CT for oncologic surveillance. Imaging demonstrated an incidental 7.5-cm intensely FDG-avid mass (SUVmax: 13.0) in the left lower abdominal wall, suspicious for metastatic disease. Incisional biopsy revealed fibrosis with multiple suture granulomas and foreign-body giant cell reaction, without malignancy. The patient had undergone transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction more than 10 years earlier, with subsequent ventral hernia mesh repairs. This case illustrates an important FDG-PET/CT pitfall of suture granuloma at remote reconstructive donor sites, which can mimic malignancy, persisting even decades after surgery.