Diagnostic ultrasound ( PDFDrive )

518 PART II Abdominal and Pelvic Sonography
L
S
A
B
U
O
C
D
E
F
FIG. 14.29 Pseudomyxoma Peritonei. (A) Sagittal ultrasound image of the right upper quadrant shows complex luid surrounding the liver
(L) shows very mild and subtle scalloping of the deep border of the liver. (B) Sagittal ultrasound image of the left upper quadrant shows the spleen
(S) surrounded by highly complex and echogenic luid. The echogenic components of the luid do not move with gravity. There is an indentation
on the convexity of the spleen where the peritoneal process appears to invaginate the splenic parenchyma. (C) Sagittal transabdominal pelvic
sonogram shows a normal anteverted uterus (U). The pouch of Douglas is illed with highly complex luid. (D) Oblique sagittal ultrasound image
of the right abdomen at the pelvic brim shows a thin-walled intraperitoneal cyst with intracystic septations. This is not within the normal appearing
right ovary (O). The normal left ovary was seen elsewhere. (E) Transverse image in the right paracolic gutter shows a “starburst” within the luid
(arrow). This is associated, in our experience, with the presence of mucin in the peritoneal cavity. (F) Highly echogenic plaque-like structure anteriorly
represents a very thick and abnormal omentum, an “omental cake.” There are hypoechoic nodules within the cake that are highly suggestive of
tumor deposits. (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 )