Pseudomyxoma peritonei with progressive calcifications: CT findings

Development of abdominal calcifications due to pseudomyxoma peritonei is rare. The authors present three cases whereby computed tomographic (CT) studies during or after chemotherapy for pseudomyxoma peritonei demonstrated development and progression of punctate calcifications in the abdomen. The clinical and CT findings of these cases are presented together with a brief review of the pertinent literature.     

腹膜假性黏液瘤的声像图特征及超声诊断价值

目的探讨腹膜假性黏液瘤（PMP）的声像图表现。方法对11例PMP患者的临床、病理及声像图表现进行回顾性分析,观察低频与高频探头扫查的声像图特征及腹水特征,确定病灶形态、部位和范围及彩色血流情况;观察腹壁、病灶内部结构及其与毗邻脏器的关系,并行超声分型。结果11例PMP中10例术前超声诊断基本符合或对临床诊断有提示作用,误诊1例,9例出现明显腹水。超声分型表现：以蜂窝状增厚型表现为主3例,分隔多房型表现为主4例,以实块型表现为主3例,3型间有交叉表现;2例表现为全腹病变,4例显示原发灶。11例均未显示血流;高频显示病灶内呈囊泡状表现且对周围脏器有特征性压迹。结论PMP超声声像图表现有一定特异性：PMP的腹水流动性差,病灶内部多呈囊泡状或可见分隔,典型的病例还可见到絮状或蜂窝样网膜组织包裹腹腔脏器,超声诊断不困难,诊断符合率较高。可作为临床明确诊断的有效检查方法。对于影像学诊断有一定困难的病例,可进行超声引导下穿刺活检以明确诊断。     

Calcified rims: Characteristic but uncommon radiologic finding in pseudomyxoma peritonei

Curvilinear calcifications on abdominal radiographs are described in a patient with pseudomyxoma peritonei, and the literature on the radiographic findings in this disease is reviewed. This sign is infrequent but characteristic. Other radiographic features of the case are also presented, as well as ultrasound and gallium scans. The latter have not been reported previously in pseudomyxoma peritonei and showed the uncommon finding of cold lesions.     

腹膜假性黏液瘤的超声表现与手术病理对照分析

目的 通过比较腹膜假性黏液瘤(PMP)超声表现与手术探查所见,探讨超声在检查PMP中的诊断价值.方法 对22例手术和/或超声引导下穿刺活检病理证实为PMP患者的声像图表现和外科手术病理结果 进行回顾性分析及比较.结果 22 例中术前超声检查提示PMP 21例,漏诊1例,诊断准确率95.5%.超声分型表现:以腹水表现为主8例,以腹膜增厚表现为主伴腹水14例(7例以蜂窝状增厚为主,7例以肿块型增厚为主).14例以腹膜增厚表现为主的PMP,彩色多普勒血流成像显示稀疏血流信号7例,另7例未见血流信号.17例进行了手术治疗,术中见大网膜呈板状增厚6例,其中4例术前超声显示网膜普遍增厚;手术中见大网膜呈结节状5例,术前超声所见2例;手术见果冻样腹水11例,而术前超声检查15例呈黏液样腹水;术中发现病变原发于阑尾或回盲部6例,而术前超声诊断仅发现1例.结论 超声检查对PMP有较高诊断准确率,应作为首选影像诊断手段;PMP的超声表现为黏液样腹水和大网膜普遍或结节状增厚,具有较高特异性,而对原发病灶显示率较差.     

Pseudomyxoma peritonei from metastatic colloid carcinoma of the breast

Cystic lesions involving the peritoneum and/or mesentery are uncommon. We present a case of metastatic mucinous adenocarcinoma of the breast to the peritoneum, a new entity to be added to the list of diagnoses that may present with this appearance.     

腹膜恶性间皮瘤7例临床病理分析

目的探讨腹膜恶性间皮瘤(PMM)的临床病理特征、免疫表型、鉴别诊断、治疗及预后。方法对7例PMM的临床资料、病理特点及免疫组化标记进行研究,并复习相关文献。结果 PMM好发于中老年人,平均年龄为61.5岁,临床主要表现为腹胀、腹痛、腹水、腹部包块等。镜下肿瘤组织形态多样,由上皮样细胞和梭形细胞2种类型组成,具有向上皮和肉瘤样双向分化的特点。免疫组化示calretinin(6例)、AE1/AE3(7例)、EMA(5例)、CK5/6(5例)、HBME-1(6例)、vimentin(7例)均(+),CEA均(-)。随访6～30个月,2例死亡,5例存活。结论 PMM对其确诊需结合临床特征、病理形态及免疫表型,根据肿瘤细胞异型程度、核分裂象多少和核的多形性,恶性间皮瘤可分为低度恶性和高度恶性。且需与腹腔原发或转移的其他肿瘤相鉴别。     

Synchronous mucinous tumors of the ovary and the appendix associated with pseudomyxoma peritonei: CT findings

Background: To present the computed tomographic (CT) findings of synchronous mucinous tumors of the ovary and the appendix associated with pseudomyxoma peritonei (PMP). Methods: Imaging studies, mainly abdominal CT scans, of three women aged 49–75 years were reviewed. Attention was directed to the ovarian masses, peritoneal seeding, and the presence of an appendiceal mucocele. Results: The ovarian tumors and the appendiceal mucocele were clearly demonstrated in two cases, and they were part of the extensive PMP in the third patient. Ascites was found in all cases, with internal septation in one. Associated scalloping of the liver margins and hypodense peritoneal implants, with extensive bowel involvement, were seen in another one. Pathologically, there was one case of right ovarian mucinous cystadenoma and villous adenoma of the appendix, one case of right ovarian and appendiceal mucinous cystadenocarcinoma, and one case of bilateral metastatic ovarian implants of appendiceal mucinous cystadenocarcinoma. PMP was found in all. In the case with benign tumors of the ovary and the appendix, the PMP was classified as a benign mucinous spillage. This patient returned 33 months after surgery with PMP, in which epithelial cells were found. Conclusions: Radiologists should be familiar with the clinical occurrence of synchronous mucinous tumors of the ovary and the appendix associated with PMP and with the typical CT findings of the latter two entities. Alternatively, when the imaging findings suggest ovarian cystic tumor with PMP, the radiologist should be alerted to the probability of a clinically unsuspected appendiceal mucocele and should search for it. Received: 10 August 1999/Accepted: 22 September 1999     

Peritoneal mesothelioma: Sonographic findings in nine cases

Ultrasonographic findings in nine cases of peritoneal mesothelioma are presented. The most common findings were sheetlike or nodular peritoneal thickening, soft tissue masses, fixation of the intestinal loops, mesenteric thickening, and minimal ascites which was disproportional to the degree of tumor dissemination. The authors found that abdominal sonography, using 3.75–7.5 MHz transducers, is a useful imaging method for diagnosis of peritoneal mesothelioma in high-risk groups.     

Peritoneal ovarian metastases simulating liver parenchymal metastases

Ovarian carcinoma frequently metastasizes to the peritoneum, both locally in the pelvis and elsewhere. Computed tomography (CT) has a limited ability to identify peritoneal implants with a diameter of 2 cm or less. Three cases of subphrenic, diaphragmatic peritoneal implants, preoperatively at CT thought to represent liver parenchymal metastases, are presented. The difficulty in the differentiation of diaphragmatic peritoneal implants from metastases to the capsule and parenchyma of the liver is discussed. To achieve a radical liver resection in patients with ovarian carcinoma, metastatic peritoneal implants must be excluded during operation.     

腹膜假性粘液癌的CT诊断

【目的】探讨腹膜假性粘液癌（PMCA）的CT影像学表现。【方法】回顾性分析经手术病理证实4例PMCA,其原发病灶为胃粘液癌、胆管粘液腺癌、阑尾高分化粘液腺癌和卵巢粘液囊腺癌各1例。【结果】4例发现原发病变,3例CT盆、腹腔粘液性腹水,显示斗篷征和扇贝征。3例腹膜和（或）网膜增厚、网膜饼形成,2例右膈下腹壁结节,1例病灶见钙化灶。【结论】盆腹腔脏器原发肿瘤病灶出现斗篷征和扇贝征,并发腹膜的增厚、腹膜结节和强化、肠道系膜的浸润,有助于PMCA诊断。     

A rare cause of ascites: pseudomyxoma peritonei and a review of the literature

Pseudomyxoma peritonei is rare. The rarity is highlighted by the lack of published evidence regarding management. The latest treatments have altered the prognosis of a once incurable disease. This report serves to both raise awareness and critically appraise the literature regarding the latest management.     

石棉相关性恶性腹膜间皮瘤的CT 诊断

目的 分析石棉相关性恶性腹膜间皮瘤的CT 表现,以期提高认识.方法 17 例病理证实的石棉相关性恶性腹膜间皮瘤患者纳入研究,男1 例,女16 例,年龄36～79 岁,平均53 岁.螺旋CT 全腹部扫描,层厚5 mm,平扫后以3 ml/s 注射非离子型碘对比剂90 ml,动脉期（延迟30 s）和门脉期（延迟70s）采集.2 位资深CT 诊断医生共同回顾性评价分析.结果 全部病例出现肠系膜增厚、混浊和腹水（100%）,其中10 例为中大量,3 例包裹;大网膜增厚16 例（94%）,其中14 例呈饼状,10 例显示增粗血管影,3 例形成大网膜肿块,明显强化;腹膜结节状及条状增厚12 例（82%）;5 例形成盆腔肿块（29%）,其中2 例部分囊性;伴淋巴结增大8 例（47%）.同时在膈面层面范围内显示胸膜斑15 例（88%）、胸腔积液5 例以及合并恶性胸膜间皮瘤1 例.结论 石棉相关性恶性腹膜间皮瘤的CT 表现有一定特征性,广泛的网膜、系膜、腹膜增厚及腹水,结合胸膜斑和石棉接触史病史,有助于诊断.     

Chylous ascites: CT and ultrasound appearance

An unusual but pathognomonic appearance of chylous ascites was observed on computed tomographic (CT) and ultrasound examinations of the abdomen in a patient with AIDS and disseminated tuberculosis. The images showed gradual development of fat-fluid level in the peritoneal collection when the patient maintained a recumbent position. The explanation for this phenomenon is provided together with a brief review of pertinent literature.     

Malignant peritoneal mesothelioma: Marked variability of CT findings

Three pathologically proven cases of malignant peritoneal mesothelioma (MPM) are shown with markedly different computed tomographic (CT) appearances. The first presented as a large enhancing pancreatic mass, a second with diffuse solid large intraperitoneal masses enveloping bowel and mesentery, and a third with predominance of ascites and small peritoneal nodules. In only one patient was there a history of possible asbestos exposure. The CT findings, pathology, and differential diagnosis of MPM are discussed.     

Cystic peripheral cholangiocarcinoma: sonography and CT

A case of cystic peripheral cholangiocarcinoma is presented. Both sonography and computed tomography (CT) demonstrated a large intrahepatic cystic neoplasm containing an enhancing solid portion. Despite the very rare incidence of this tumor, we believe that cystic degeneration of peripheral cholangiocarcinoma should be considered with these radiologic findings.     

F-FDG-PET/CT in malignant mesothelioma

It is well known the useful role of ¹⁸F-FDG-PET/CT for differential diagnosis between benign and malignant disease, for staging, for monitoring response and for prognosis regarding mesothelioma. Recently, literature was enriched with new interesting studies regarding the potential applications of ¹⁸F-FDG-PET/CT in this field. The purpose of this review is to evaluate articles published on line (PubMed) from January 2011 until October 2012 in order to obtain an overview of recent progress of molecular imaging in malignant mesothelioma. The main topics concern the use of ¹⁸F-FDG-PET/CT in radiation therapy planning, monitoring of treatment (surgery/chemotherapy) response and prognosis assessment.     

Peritoneal fluid in children with intussusception: Its sonographic detection and relationship to successful reduction

A retrospective review of the abdominal/pelvic ultrasound (US) examinations in 21 consecutive children with intussusception proven on barium enema was performed to determine what is the incidence of US detected peritoneal fluid in this population and to see if the rate of reduction was different in this subset. Twelve of the 21 children (57%) had free fluid demonstrated with US. Eight of these 12 (67%) had successful reduction. Six of the nine children (67%) without free fluid were also successfully reduced.     

Cluster scanning in body CT

Rapid, dynamic computed tomography (CT) is essential in scanning the body in order to maintain adequate contrast enhancement during the entire examination. In the case of the liver, this is most critical in order to complete scanning prior to the equilibrium phase when lesions are less conspicuous or may be missed entirely. This technical note describes the application of cluster scanning to conventional scanning in order to optimize body CT by decreasing the total exam time.This work was supported in part by a grant from General Electric Medical Systems (Milwaukee, WI, USA). Dr. Silverman is the recipient of a research and development award from General Electric Medical Systems.     

主动脉瘤先兆破裂及破裂的CT诊断价值

目的:探讨主动脉瘤先兆破裂及破裂的CT征象.方法:回顾性分析主动脉瘤21例的临床及CT扫描资料.结果:主动脉瘤先兆破裂及破裂的CT征象包括:主动脉旁血肿11例,活动性造影剂外渗5例,主动脉包含征4例,胸腔积血4例,心包积血3例,主动脉瘤壁钙化15例,主动脉瘤附壁血栓8例,动脉瘤增大5例.结论:CT可显示主动脉瘤先兆破裂及破裂的CT征象,有助于其及时诊断.     

恶性胸膜间皮瘤X线与CT的应用比较

目的分析恶性胸膜间皮瘤的X线胸片和CT征象,并比较两种方法对恶性胸膜间皮瘤的诊断价值。方法回顾性分析18例经组织学证实的恶性胸膜间皮瘤的X线胸片和CT图像。结果恶性胸膜间皮瘤的X线和CT征象包括结节状胸膜增厚、环状胸膜增厚以及纵隔、胸壁侵犯等。X线和CT诊断恶性胸膜间皮瘤的准确率分别为9/18和14/18。结论CT在确定恶性胸膜间皮瘤的病变部位、范围及分期方面较X线胸片有其优势。