Learning objectives
To review and help understand the complex imaging anatomy of peritoneum,
including peritoneal spaces and reflections with corresponding CT images.
To describe the route of spread of disease across the potential spaces and ligaments.
Background
Peritoneal spaces and reflections that form ligaments,
mesentery and omentum arefrequently involved secondary to inflammatory,
infectious,
traumatic and neoplastic diseases.The peritoneal spaces,
reflections and the natural flow of peritoneal fluiddetermine the route of spread of disease processes.
Hence,
an accurate knowledge of imaging anatomy allows localisation of pathology and help in narrowing thedifferential diagnoses.
Peritoneal cavity is a potential space between parietal and visceral peritoneum.In men,
the peritoneal cavity is closed,
but in women,
it communicates with theextraperitonealpelvis exteriorly through the fallopian tubes,
uterus,
and...
Findings and procedure details
In this presentation,
CECT images of a 53 year old lady who is a known case of Neurofibromatosis with complaints of abdominal distension and on imaging found to have gross ascites and bilateral adnexal lesions are used for demonstration of anatomy of peritoneal spaces and reflections.
Other cases for illustration of variouspathological processes involving peritoneum with emphasis on route of spread will follow after review of anatomy.
Peritoneal ligaments
Suspensory ligaments of liver
Include thetriangular andfalciformligaments.
TriangularLigaments
Outlinethe bare area of liver.Theleft triangular ligament is...
Conclusion
Important teaching points of this poster are summarised as follows:
Transverse mesocolon divides the peritoneum into supramesocolic and inframesocolic spaces.
Collections in right inframesocolic space donot extend to pelvis as it is limited inferiorly by attachment of small bowel mesentery to cecum.
Left inframesocolic spacecommunicates freely with the pelvis.
Hepatoduodenal ligament acts as route of spread of pancreatic pathology to porta hepatis.
In carcinoma pancreas,
involvement of mesentery or transverse mesocolon renders the tumor unresectable as vascular control becomes difficult.
To conclude,
knowledge of peritoneal...
Personal information
Dr.
Minu Mohandas MBBS
Radiology Resident
Dr.
Somervell Memorial CSI Medical College,
Karakonam
Email id:
[email protected]
References
1.TirkesT,SandrasegaranK,
Patel AA,HollarMA,
Tejada JG,
Tann M,
et al.
Peritoneal and Retroperitoneal Anatomy and Its Relevance for Cross-Sectional Imaging.RadioGraphics.
2012 Mar 1;32(2):437–51.
2.Gore RM,
Levine MS,
editors.
Textbook of gastrointestinal radiology.
3rd ed.
Philadelphia: Saunders/Elsevier; 2007.
3.DeMeoJH,
Fulcher AS,
Austin RF.
Anatomic CT demonstration of the peritonealspaces,
ligaments,
and mesenteries: normal and pathologic processes.RadioGraphics.
1995 Jul 1;15(4):755–70.