Diagnostic ultrasound ( PDFDrive )

CHAPTER
14
The Peritoneum
Anthony E. Hanbidge, Korosh Khalili, and Stephanie R. Wilson
SUMMARY OF KEY POINTS
• Ultrasound has a role in peritoneal imaging.
• Success is dependent on operator awareness and
thorough technique.
• Inclusion of transvaginal scan in women will greatly
improve accuracy.
• Ultrasound is excellent for detecting and characterizing
peritoneal luid.
• Ultrasound is very useful for detecting and characterizing
neoplastic and inlammatory peritoneal disease.
• Ultrasound is often the modality of choice to guide
paracentesis and biopsy of peritoneal masses.
CHAPTER OUTLINE
PERITONEUM, OMENTUM, AND
MESENTERY
SONOGRAPHIC TECHNIQUE
ASCITES
PERITONEAL INCLUSION CYSTS
(BENIGN ENCYSTED FLUID)
MESENTERIC CYSTS
PERITONEAL TUMORS
Peritoneal Carcinomatosis
Primary Tumors of Peritoneum
Pseudomyxoma Peritonei
INFLAMMATORY DISEASE OF
PERITONEUM
Abscess
Tuberculous Peritonitis
Sclerosing Peritonitis
LOCALIZED INFLAMMATORY
PROCESS OF PERITONEAL
CAVITY
RIGHT-SIDED SEGMENTAL
OMENTAL INFARCTION
ENDOMETRIOSIS
LEIOMYOMATOSIS PERITONEALIS
DISSEMINATA
PNEUMOPERITONEUM
CONCLUSION
Ultrasound of the abdomen and pelvis has become an extension
of the physical examination when evaluating patients
with abdominal symptoms and signs. It is accurate, safe, readily
available, portable, and relatively inexpensive. Evaluations have
traditionally focused on assessing the solid viscera, the gallbladder,
and bile ducts. Frequently, images of only these organs are
recorded, and the peritoneal cavity is oten neglected or subjected
to cursory evaluation. he general belief is that ultrasound is
not particularly helpful at imaging the peritoneum because of
technical limitations, such as poor visibility and interference
from bowel gas. here is also unfamiliarity with the common
sonographic features encountered with peritoneal disease, as
relected by extensive literature on ultrasound of the liver, gallbladder,
bile ducts, pancreas, spleen, kidneys, bladder, and reproductive
organs but little on sonographic evaluation of the peritoneum
and peritoneal cavity. As a result, teaching of optimal sonographic
technique to evaluate these areas is minimal.
If peritoneal disease is a clinical concern, computed tomography
(CT) 1,2 or magnetic resonance imaging (MRI) 3-5 is generally
used to investigate. We believe that ultrasound can also be sensitive
and speciic in this regard. 6 To be successful, however, two criteria
must be met: (1) the operator must be aware of the potential
involvement of the peritoneum and peritoneal cavity with a
disease process, and (2) these areas must receive a thorough
sonographic assessment.
PERITONEUM, OMENTUM,
AND MESENTERY
he peritoneum is a serous membrane lined with epithelial cells.
It is divided into the parietal and visceral peritoneum. he parietal
peritoneum lines the anterior and posterior walls of the abdominal
cavity and is visible with ultrasound as a thin, smooth, echogenic
line in the deepest layer of the anterior abdominal wall. Bowel
loops can usually be seen deep to the parietal peritoneum, moving
independent of it with respiration. he visceral peritoneum, on
the other hand, covers the intraabdominal organs and is not
visible with ultrasound in its normal state. he potential space
between these two layers is known as the peritoneal cavity,
which usually contains a small volume of luid that acts as a
lubricant. 7,8
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