A Case of Pseudomyxoma Peritonei with Bilateral Pleural Metastases

A case of pseudomyxoma peritonei that was first recognized bydyspnea and abnormal shadows on chest X-ray film is reported.The patient is a 67-yr-old woman who was found to have an abnormalshadow on chest X-ray filni on routine physical examinationwhen she was 47 yr old (1960). She had been asymptoniatic untilabout 2 yr before admission when she began to experience dyspneawith increased severity. On admission, the chest X-ray filmand com puted tomography showed bilateral pleural thickening.Drainage and decortica tion was carried out, and multiple cystsfilled with a gelatinous substance were found bilaterally inthe thoracic cavity. On the 66th hospital day, pan- peritonitisfollowing perforation of the appendix occurred and an emergencyoperation was performed. The patient died of acute renal failureon the 13th postoperative day. Pseudomyxoma peritonei originatingfrom pseudomucinous cystadenocarcinoma of the appendix was diagnosedon the basis of the findings of the histopathological examination.At autopsy, the gelatinous substance was found in both pleuralcavities, the right subphrenic area, and part of the large omentum.The case presented here is a very rare case of pseudomyxoniaperitonei, because dyspnea was the main feature and abdominalsymptoms such as abdominal distension and pain were lacking.Then high level of serum carcinoenibryonic antigen seen in thiscase is also pointed out.