Learning objectives
- To describe the main differential diagnoses of peritoneal carcinomatosis.
- To make a pictorial review of CT imaging of patients from our institution that were misdiagnosed with peritoneal carcinomatosis.
- To appoint the key imaging findings of tumour-like diseases simulating peritoneal carcinomatosis.
Background
Peritoneal carcinomatosis is the intraperitoneal dissemination of any cancer that does not originate from the peritoneum itself.
It is the most common diffuse peritoneal disease however other entities may be responsible for peritoneal invasion.
In order to treat the patients adequately it is crucial that the radiologist can be able not only to diagnose peritoneal carcinomatosis but also to exclude its mimics.
Inflammatory and malignant diseases of the peritoneum maypresent with overlapping features both clinically and at imaging.
Awareness of the patient’s clinical history is...
Findings and procedure details
◊Peritoneal tuberculosis
Tuberculosis is still endemic in developing countries.
In the developed world there is some resurgence of the disease caused by immigration,
AIDS and the increased use of immunosuppressant drugs 2.
Peritoneal tuberculosis accounts for 1-3% of cases and it is the 6th most common extra-pulmonary site of tuberculosis 2.
There are three types of peritoneal tuberculosis 2:
Wet type: abundant ascites and increase density (20-45HU)
Fixed fibrotic type: peritoneal masses adherent to neighbouring structures; loculated ascites ( Fig. 10 )
Dry or plastic...
Conclusion
Invasive peritoneal disease includes more than peritoneal carcinomatosis.
Nowadays,
in the majority of the hospitals oncological patients represent a significant part of the radiologists daily work.
In this way there is a natural tendency to interpret invasive peritonealdisease as peritoneal carcinomatosis.
In order to make an accurate diagnosis the radiologist needs not only to recognize the imaging hallmarks of peritoneal carcinomatosis but also to correlate them with the clinical data and to exclude its mimics.
Personal information
Sara Belião
Radiologist
Radiology Department of Champalimaud Foundation,
Lisbon
[email protected]
References
Filippone A,
Cianci R et al; CT findings in acute peritonitis: a pattern-based approach; Diagn Interv Radiol; 2015 Nov-Dez; 21(6): 435-440
Diop A,
Fontarensky M et al; CT imaging of peritoneal carcinomatosis and its mimics; Diagnostic and Interventional Imaging; Vol 95; Issue 9;Sep 2014: 861-872
Rakheja R,
Makis W,
et al; Bilateral Tubo-Ovarian Abscess Mimics Ovarian Cancer on MRI and 18F-FDG PET/CT; Nucl Med Mol Imaging (2011) 45:223–228
Wang T,
Li W,
et al; Tubo-Ovarian Abscess (with/without Pseudotumor Area) Mimicking Ovarian Malignancy: Role of Diffusion-Weighted...