Diagnostic ultrasound ( PDFDrive )

510 PART II Abdominal and Pelvic Sonography
U
A
B
R
L
C
D
FIG. 14.12 Pelvic Lymphangioma in Asymptomatic Woman. (A) Transverse TVS shows the normal uterus (U) in cross section, surrounded
by innumerable cysts with thin septations. There is no nodularity. Real-time examination suggested that these cysts were soft and compliant.
(B) TVS lateral to the uterus shows that the cystic changes are extensive. Their distribution and extent do not suggest an ovarian origin. (C) Two
TVS images show a normal right (R) and a normal left (L) ovary. This excludes the ovaries as a source of the pathology. (D) Axial T2-weighted MRI
conirms the extensive intraperitoneal thin-walled cystic masses (arrows). (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 )
Asymptomatic cysts are frequently managed conservatively,
particularly if simple or with the typical appearance of a lymphangioma.
Surgery is usually reserved to alleviate pressure
symptoms or to address acute complications.
PERITONEAL TUMORS
Tumors involving the peritoneum are oten encountered with
ultrasound and are generally malignant. Metastatic tumors are
much more common than primary peritoneal tumors. he ovary
is the primary site of disease in the vast majority of female patients.
Other sites of primary disease with a propensity to spread to
the peritoneum include the stomach, colon, breast, pancreas,
kidney, bladder, uterus, and skin (melanoma).
Peritoneal Carcinomatosis
Peritoneal carcinomatosis is the term used to describe difuse
involvement of the peritoneum with metastatic disease. Carcinomatous
seeding involving the parietal peritoneum (Fig. 14.13,
Fig. 14.14A, Video 14.4) or visceral peritoneum (Figs. 14.14B
and 14.15, Videos 14.5 and 14.6) may produce discrete hypoechoic
nodules, irregular masses, or hypoechoic rind-like thickening
L
K
FIG. 14.13 Parietal Peritoneal Metastasis From Squamous Cell
Carcinoma of the Lung. Sagittal image of the right upper quadrant
shows a hypoechoic nodule (arrow) anterior to the liver (L). With respiration,
the liver moved freely and independent of the nodule, which stayed
stationary, correctly suggesting its location on the parietal peritoneum.
K, Kidney. See also Video 14.4.