Diagnostic ultrasound ( PDFDrive )

CHAPTER 14 The Peritoneum 509
A
B
FIG. 14.10 Fibrinous Peritonitis. (A) Axial, contrast-enhanced pelvic CT scan shows loculated luid in the pouch of Douglas and left adnexa
with an enhancing rim (arrow). (B) Transverse TVS shows the high degree of complexity of this luid (arrow) to much better advantage.
O
O
A
B
FIG. 14.11 Peritoneal Inclusion Cyst. (A) Transverse TVS of the right adnexa. (B) Axial T2-weighted MRI through the midpelvis. Both images
show the normal right ovary (O) surrounded by encysted luid, conforming to the contours of the peritoneal cavity. (Reproduced from Wilson SR.
Pseudomyxoma peritonei. In: Cohen HL, editor. Gastrointestinal disease, test and syllabus. Reston, VA: American College of Radiology; 2004.
pp. 73-84. 28 )
misinterpreted as representing ovarian cysts, parovarian cysts,
hydrosalpinges, or even ovarian cancer. he key to the correct
diagnosis is to suspect this condition based on the patient’s proile,
then demonstrate a normal ovary, either within or on the margin
of the inclusion cyst, most oten with TVS (Fig. 14.11). Complex
peritoneal inclusion cysts are also known as multicystic
mesotheliomas. 29
MESENTERIC CYSTS
Mesenteric cysts are rare intraabdominal masses oten discovered
incidentally at imaging. However, they may present clinically
with abdominal distention because of their size, or acutely with
pain because of a complication such as hemorrhage, rupture, or
torsion. Mesenteric cysts are most oten of lymphatic (lymphangioma)
or mesothelial origin but may also be of enteric (enteric
duplication cyst) or urogenital origin. Dermoid cysts and
pseudocysts (infectious, inlammatory, or traumatic) are seen
as well. 30,31 Mesenteric cysts vary in size from less than 1 cm to
greater than 25 cm, illing the entire peritoneal cavity. hey may
be entirely simple to highly complex with extensive internal
septations, as sometimes seen with lymphangiomas 32,33 (Fig.
14.12). Smaller mesenteric cysts are frequently mobile, changing
location with palpation or with changes in the patient’s position.