Diagnostic ultrasound ( PDFDrive )

514 PART II Abdominal and Pelvic Sonography
A
B
FIG. 14.20 Peritoneal Implant Without Ascites. (A) Transverse ultrasound image and (B) axial CT image of the right upper quadrant show
a small peritoneal implant (arrow) overlying segment 7 of the liver. Note that the implant is better appreciated on the ultrasound image.
FIG. 14.21 Peritoneal Carcinomatosis From Ovarian Cancer. Oblique
sagittal TVS shows small (<5 mm), parietal (near-ield), and visceral
(far-ield) peritoneal implants (arrows), surrounded by particulate ascites.
FIG. 14.22 Free-Floating “Omental Cake.” Sagittal ultrasound
image of the lower midline abdomen shows an omental cake (arrows)
loating freely in the ascitic luid. Note the free edge of the abnormal
greater omentum inferiorly.
Patients with pseudomyxoma peritonei present with abdominal
pain and distention. Ultimately, the bowel becomes encased with
mucinous material, and bowel obstruction may occur. Repeated
surgical intervention to remove the accumulated mucinous
material remains the treatment of choice. 52 Perioperative intraperitoneal
chemotherapy may add additional beneit. 53 Because
patients present with abdominal symptoms, the diagnosis is
frequently made preoperatively by ultrasound or CT. 54 Sonography
frequently shows complex ascites relecting the gelatinous nature
of the luid. he echogenic foci within the luid are nonmobile,
and the bowel loops, instead of loating freely, are displaced
centrally and posteriorly by the surrounding mass, giving a
characteristic “starburst” appearance 55 (Fig. 14.29). Scalloping
of the liver is another typical feature of pseudomyxoma peritonei. 56
Ultrasound may be helpful to guide paracentesis in these patients
because less viscous areas may be identiied, with a greater
likelihood of successful aspiration.
INFLAMMATORY DISEASE OF
PERITONEUM
Peritonitis is deined as difuse inlammation of the parietal and
visceral peritoneum, with both infectious and noninfectious
causes. 3 Infectious causes include bacteria (including tuberculosis),
viruses, fungi, and parasites. Noninfectious causes are less
common and include chemical peritonitis (secondary to gastric
or pancreatic juice or bile), granulomatous peritonitis (secondary
to foreign bodies such as talc), and sclerosing peritonitis associated
with continuous ambulatory peritoneal dialysis.