IS Case 162: Pseudomyxoma peritonei
Imaging Sciences URMC 2008
Publication Date: 2009-05-21
Diffuse scalloping of the liver and spleen contour. Extensive peritoneal fluid of varying attenuation, which also contains a small amount of gas, likely due to superimposed infection. Peritoneum is diffusely thickened and enhanced.
Pseudomyxoma peritonei is a rare condition in which the peritoneal cavity fills with gelatinous material (mucin), associated with implants on the peritoneal surfaces and omentum. The main etiologies include ruptured appendiceal mucocele, intraperitoneal metastasis from ovarian, colon, and occasionally pancreatic adenocarcinomas.
On CT pseudomyxoma peritonei is classically characterized by scalloping of the spleen and liver margins, as demonstrated in this case. There may also be multilocular cystic masses and septa with rims of curvilinear calcifications. While loops of bowel may be displaced centrally, the bowel is relatively spared until late in the disease process. The presence of pneumoperitoneum may suggest superimposed infection.
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