In this exhibit, imaging findings in a variety of pathologic conditions, which cause omental cakes, are presented, with emphasis on key findings that is crucial for establishing the diagnosis. As problem solving technique for establishing the diagnosis, the indications and procedure details of image guided biopsy for omental cake is initially introduced.

Omental cake is the condition in which implanted neoplastic cells diffusely involve the omentum, and can result from a variety of conditions, mainly results from dissemination of malignancy. In most of cases, CT or US is a usually initial modality to detect omental cake.On CT, omental cake is demonstrated as areas of soft tissue attenuation or diffuse or reticular appearance in the thickened omentum, which is enhanced on postcontrast images (Fig.1). Occasionally coarse nodule may be present in the thickend omentum (Fig.2). US typically shows...

I. Image guided biopsy for omental cake 1) Indication The indication for image-guided biopsy is the patients who were found to have omental cake but without any clinically apparent primary. CT is commonly used modality of choice for image-guidance. However, ultrasonography also have some advantages for biopsy, and is usually applied in our institute. Real-time visualization on US have advantages in avoiding vessels and intestine. The success of the procedure depends on the proficiency of the operator. Reported sensitivity and specificity of image-guided biopsy are...

The knowledge of imaging findings in various etiologies of omental cake and technique of image-guided biopsy will help establishing final diagnosis.

K. Kuriyama; Kurashiki/JP - nothing to disclose T. Koyama; Kurashiki/JP - nothing to disclose S. Nakashita; Kurashiki/JP - nothing to disclose K. Nakatani; Kurashiki/JP - nothing to disclose Y. Ishizaka; Kurashiki/JP - nothing to disclose K. Notohara; Kurashiki/JP - nothing to disclose

1. Levy AD, Arnaiz J, Shaw JC, Sobin LH. Primary peritoneal tumors: imaging features with pathologic correlation. RadioGraphics 2008;28:583–607. 2. Richard Bellah, et al. Desmoplastic Small Round Cell Tumor in the Abdomen and Pelvis: Report of CT Findings in 11 Affected Children and Young Adults. AJR 2005;184:1910–1914 3. Seshul MB, Coulam CM. Pseudomyxoma peritonei : computed tomography and sonography. AJR Am J Roentgenol 1981;136:803–806 4. Joshua Burrill, FRCR, et al. Tuberculosis: A Radiologic Review RadioGraphics 2007; 27:1255–1273 5. Suk Hee Heo, et al. Imaging of...