Diseases of the Peritoneum and Retroperitoneum

h Diseases of the Peritoneum and Retroperitoneum

• Is the abnormality cystic or solid?

• Is the abnormality focal (tumorlike) or diffusely infiltrating?

Somewhere In Between

Mary Soames (64) has lost 6 kg within a few weeks. She has not really felt well for more than two months. Joey is the first to have a look at the abdominal CT that was done to find the reason for her weight loss. He notices a lesion in the posterior abdomen that he cannot assign to a specific organ (Fig. 9.65). To get to the heart of this he starts with the basics.

^ What is Your Diagnosis?

Ascites: Ascites may develop in a number of diseases, liver cirrhosis being the most frequent (see Fig. 9.49b). Diffuse metastases in the abdomen that sit directly on the peritoneal surfaces also cause ascites (Fig. 9.66a). If the peritoneal carcinomatosis is severe, solid tumor nodules and diffuse thickening of the omentum ("omental caking") may be observed (Fig. 9.66b, c). A paralytic ileus may also ensue (Fig. 9.66d).

I Islet Cell Tumor

I Islet Cell Tumor

Omental Caking Picture

Fig. 9.64 This insulinoma (arrow) enhances markedly in the arterial phase of contrast administration. Small tumors can escape detection completely. A nuclear medicine study with radiolabeled octreotide is a very sensitive test to detect even small islet cell tumors. Modern hybrid scanners combine images of the metabolic activity of the tumor with the superb anatomical detail one is acquainted with from CT images.

Fig. 9.64 This insulinoma (arrow) enhances markedly in the arterial phase of contrast administration. Small tumors can escape detection completely. A nuclear medicine study with radiolabeled octreotide is a very sensitive test to detect even small islet cell tumors. Modern hybrid scanners combine images of the metabolic activity of the tumor with the superb anatomical detail one is acquainted with from CT images.

I The Case of Mary Soames

Fig. 9.65 Analyze the relevant CT sections of Mrs. Soames. What grabs your attention immediately?

I Peritoneal Carcinosis

Retroperitoneum Cross Section

Fig. 9.66a The ultrasound cross-section shows the liver surrounded by ascites. There is a tumor at the underside of the diaphragm. It is a peritoneal metastasis of a pancreatic carcinoma. b The CT of another patient shows some tumor nodules in the omentum (arrows) ventral to the liver. c The extensive

0 0

Post a comment