CT FINDINGS OF CARCINOMATOSIS PERITONEI

Abstract

OBJECTIVE 1. To illustrate the CT findings in 15 cases of carcinomatosis peritonei
2. To determine the suggestive signs of carcinomatosis peritonei.
Abdominal CT scans in fifteen patients with proven carcinomatosis peritonei were reviewed retrospectively. CT findings were evaluated for: 1) the presence, amount and distribution of ascites; 2) the morphologic appearance of the peritoneum, omentum, mesentery and bowel 3) the presence of lymphadenopathy and hepatosplenic involvement.
The peritoneum was thickened and enhanced after intravenous contrast in all cases. Ascites was present in fourteen patients and was large in eight patients. Loculation of the fluid occurred in seven patients. In three patients, despite generalized ascites; there was a notable lack of ascitic fluid in the cul-de-sac. Mesenteric infiltration was noted in twelve cases. Omental involvement was visible as soft tissue permeation of fat, enhancing nodules and/or extrinsic omental masses in nine cases. Bowel wall thickening was present in three cases. Masses in the cul-de-sac were found in five cases and were believed to represent drop metastases. Lymphadenopathy was present in four cases, liver metastasis in five cases and splenic metastasis in three cases.
Carcinomatosis peritonei should be suspected when there is enhancing peritoneal thickening accompanied by a large amount of ascites, mesenteric infiltration or omental involvement. Although not always present, bowel wall thickening, lymphadenopathy and hepatosplenic metastases also support the diagnosis.