History :
This 58 y/o gentalman got general malaise and body weight loss 3kg/6months
since half a year ago.
Image finding :
Segmental circumferential irregular wall thickening of the proximal
descending colon with very stenotic lumen, Ectensive soft tissue density
around the bilateral paracolic gutter, bilateral subphrenic region
with concave hepatic surface. Cancerous peritonitis with peritoneal
implantation and psudedomysoma peritonei is compatible.
Diagnosis :
Colon cancer with carcinomatosis
Discussion :
PERITONEAL METASTASES
=PERITONEAL CARCINOMATOSIS =intra-abdominal spread of malignant
tumors Origin:
-(a)common: ovary, stomach, colon
-(b)less common: pancreas, uterus, bladder
*massive ascites
*desmoplastic reaction at (a) anterior border of rectum (Blumer
shelf) (b) mesenteric side of terminal ileum
CT:
*increased density of linear network in mesenteric fat
*loculated fluid collections in peritoneal cavity
*apparent thickening of mesenteric vessels (= fluid within leaves
of mesentery)
*adnexal mass of cystic / soft-tissue density (= Krukenberg tumor)
*small nodular densities on peritoneal surface
*"omental cake" = thickening of greater omentum
*lobulated mass in pouch of Douglas
*calcified peritoneal implants in serous cystadenocarcinoma of ovary
(in up to 40% with stage III / IV disease) |
