Spleen Capsular Calcification

Subphrenic Fat

Fig. 4-164. Peritoneal carcinomatosis.

Gadolinium-enhanced MR image with fat saturation shows a thin rim of abnormally enhancing peritoneum in the right and left subphrenic spaces (arrows). Ascites is present. At laparos-copy, carcinomatosis with diffuse miliary tumor nodules was confirmed.

(Reproduced from Low et al.138)

Fig. 4-164. Peritoneal carcinomatosis.

Gadolinium-enhanced MR image with fat saturation shows a thin rim of abnormally enhancing peritoneum in the right and left subphrenic spaces (arrows). Ascites is present. At laparos-copy, carcinomatosis with diffuse miliary tumor nodules was confirmed.

(Reproduced from Low et al.138)

Fig. 4—165. Tuberculous peritonitis.

Contrast-enhanced CT shows massive ascites and marked thickening of the visceral and parietal peritoneum, further demarcated by contrast enhancement (arrows).

(Courtesy of Hiromu Mori, M.D., Oita Medical Center, Oita, Japan.)

Fig. 4—165. Tuberculous peritonitis.

Contrast-enhanced CT shows massive ascites and marked thickening of the visceral and parietal peritoneum, further demarcated by contrast enhancement (arrows).

(Courtesy of Hiromu Mori, M.D., Oita Medical Center, Oita, Japan.)

Omental Cake Tuberculosis

Fig. 4-166. Tuberculosis peritonitis.

Contrast-enhanced CT demonstrates a conspicuous omental cake (arrows) demarcated by enhanced thickened peritoneum. The small bowel mesentery is matted and conglomerated by the inflammatory process. (Reproduced from Auh et al.10)

Spontaneous Bacterial Peritonitis Images

Fig. 4-167. Spontaneous bacterial peritonitis.

Peritoneum lining the greater omentum, which is displaced posteriorly by a large loculated ascites, is conspicuously thickened and enhanced (arrows). Similar changes demarcate the parental peritoneum of the anterior abdominal wall. (Reproduced from Auh et al.10)

Fig. 4—168. Perihepatic mantle of seeded metastases.

A thin mantle of low-density material representing early seeding from a mucinous ovarian carcinoma is adjacent to the liver (arrows). It extends anteriorly to the level of the falciform ligament. There is no appreciable ascites.

Falciform Ligament HaematomaAscites With Liver Scalloping

Fig. 4—169. Perihepatic mantle of seeded metastases.

Seeded metastases from an ovarian mucinous cystadenocarcinoma are deposited on the liver capsule (arrows). This process extends from the level of the falciform ligament anteriorly to the level of the right coronary ligament posteriorly at the bare area of the liver. There is no appreciable ascites. In the older anatomic pathology literature, such thickening of the visceral peritoneum over the liver is termed "sugar-icing" (Zuckergussleber).

Fig. 4—169. Perihepatic mantle of seeded metastases.

Seeded metastases from an ovarian mucinous cystadenocarcinoma are deposited on the liver capsule (arrows). This process extends from the level of the falciform ligament anteriorly to the level of the right coronary ligament posteriorly at the bare area of the liver. There is no appreciable ascites. In the older anatomic pathology literature, such thickening of the visceral peritoneum over the liver is termed "sugar-icing" (Zuckergussleber).

Parietal Visceral Peritonei

Fig. 4-170. Pseudomyxoma peritonei.

Mild scalloping of the liver contour is related to conspicuous fluid collections in the greater peritoneal cavity (IP) and lesser sac (LS). These are inhomogeneous, with some areas showing increased density (arrows). GSL = gastrosplenic ligament. (Reproduced from Churchill and Meyers.154)

Fig. 4-170. Pseudomyxoma peritonei.

Mild scalloping of the liver contour is related to conspicuous fluid collections in the greater peritoneal cavity (IP) and lesser sac (LS). These are inhomogeneous, with some areas showing increased density (arrows). GSL = gastrosplenic ligament. (Reproduced from Churchill and Meyers.154)

Pseudomyxoma Peritonei Calcified

Fig. 4-171. Pseudomyxoma peritonei secondary to mucinous cystadenocarcinoma of the ovary.

Gelatinous cysts of varying densities produce scalloped indentations upon the liver. Discrete cysts bound the falciform ligament. Fluid collections in both the greater peritoneal cavity and lesser sac are inhomogeneous.

Fig. 4-172. Pseudomyxoma peritonei secondary to appendi-

ceal mucinous cystadenocarci-noma.

T1-weighted gadolinium enhanced MR image demonstrates scalloping of the liver margin (arrowheads) and enhancement of the gelatinous material (open arrows).

(Reproduced from Semelka et al.59)

Fig. 4-172. Pseudomyxoma peritonei secondary to appendi-

ceal mucinous cystadenocarci-noma.

T1-weighted gadolinium enhanced MR image demonstrates scalloping of the liver margin (arrowheads) and enhancement of the gelatinous material (open arrows).

(Reproduced from Semelka et al.59)

Pseudomyxoma Peritonei Calcified

Fig. 4-173. Pseudomyxoma peritonei secondary to appendi-

ceal mucinous cystadenocarci-noma.

Gadolinium-enhanced T1-weighted MR image with fat suppression demonstrates a rim of enhancing right subphrenic tumor (white arrows) and bulky tumor encasing the stomach, spleen, and splenic flexure of the colon. Enhancing tumor is also evident in the superior recess of the lesser sac (black arrow). (Reproduced from Low et al.139)

Fig. 4-173. Pseudomyxoma peritonei secondary to appendi-

ceal mucinous cystadenocarci-noma.

Gadolinium-enhanced T1-weighted MR image with fat suppression demonstrates a rim of enhancing right subphrenic tumor (white arrows) and bulky tumor encasing the stomach, spleen, and splenic flexure of the colon. Enhancing tumor is also evident in the superior recess of the lesser sac (black arrow). (Reproduced from Low et al.139)

Superior Recess The Lesser Sac

Fig. 4-174. Calcified perihepatic implants from ovarian carcinoma.

CT shows calcification along the right border of the liver that extends anteriorly along the diaphragm (arrows), where it is separated from the liver by ascites. Perisplenic calcification is also present (arrowheads). (Reproduced from Mitchell et al.159)

Calcified Metastasis Liver

Fig. 4-175. Calcified perihepatic implants from ovarian carcinoma.

Calcified seedings are seen on the liver surface (arrows). Metastatic tumor is present in (Reproduced from Gore and Meyers.24)

Fig. 4-175. Calcified perihepatic implants from ovarian carcinoma.

Calcified seedings are seen on the liver surface (arrows). Metastatic tumor is present in (Reproduced from Gore and Meyers.24)

the splenic hilum (T).

Fig. 4-176. Calcified perihepatic implants from ovarian carcinoma.

Calcified metastatic deposits are seen along the liver surface, the ligamentum teres and falciform ligament (arrows), and spleen. (Reproduced from Solomon and Rubinstein.161)

Falciform Ligament Haematoma

Fig. 4-177. Calcified perihepatic metastases from ovarian carcinoma.

The secondary malignancies have been transported and implanted in the immediate subdia-phragmatic region (arrows). (Reproduced from Solomon and Rubinstein.161)

Fig. 4-177. Calcified perihepatic metastases from ovarian carcinoma.

The secondary malignancies have been transported and implanted in the immediate subdia-phragmatic region (arrows). (Reproduced from Solomon and Rubinstein.161)

Morison's pouch, and adjacent to the spleen.137,159,161 Peritoneal calcifications secondary to gastric carcinoma are rare.163,164

Subcapsular liver metastases have been observed by CT in 13 cases of ovarian carcinoma by Triller et al.126 These are seen on CT and MR imaging as rounded or oval low-density or high-signal-intensity lesions between the liver capsule and the liver parenchyma, generally of 0.5-1 cm diameter and infrequently approaching 8 cm (Figs. 4-178 through 4-180). They are characteristically located in the dorsomedial and dor-solateral parts of the right liver lobe and may be associated with peritoneal metastases in Morison's pouch.

Presumably, cancer cells implanted on the liver surface infiltrate the capsule as well as the liver parenchyma and develop at these sites as subcapsular metastases.95,126 The lesion may regress after chemotherapy.

Distinction between subcapsular metastases and in-traparenchymal liver metastases by CT and MR imaging is important because the former do not represent a contraindication for cytoreductive surgery. It may be difficult preoperatively to differentiate between parenchymal liver metastases (potentially curable with liver resection), serosal liver lesions, and diaphragmatic peritoneal implants, the latter two representing peritoneal metastatic growth126,137,165,166 (Figs. 4-181 and 4-182). Subcapsular

Fig. 4-180. Subcapsular liver metastasis from ovarian carcinoma.

T2-weighted fat suppressed MR image demonstrates a Subcapsular liver metastasis (arrow). It presents a characteristic biconvex lens shape. (Reproduced from Semelka et al.59)

Liver Claw Sign

Fig. 4-178. Subcapsular liver metastasis from ovarian carcinoma.

A cystic mass (large arrow) indents the posterior contour of the right lobe of the liver. A "claw-sign" (small arrow) along one of its margins indicates its relationship to the parenchyma.

Fig. 4-178. Subcapsular liver metastasis from ovarian carcinoma.

A cystic mass (large arrow) indents the posterior contour of the right lobe of the liver. A "claw-sign" (small arrow) along one of its margins indicates its relationship to the parenchyma.

Fig. 4-180. Subcapsular liver metastasis from ovarian carcinoma.

T2-weighted fat suppressed MR image demonstrates a Subcapsular liver metastasis (arrow). It presents a characteristic biconvex lens shape. (Reproduced from Semelka et al.59)

Coronary Ligament Metastasis

Fig. 4—179. Subcapsular liver metastases from ovarian carcinoma.

Large lesions involve the liver.

(Courtesy of Jay Heiken, M.D., Mallinckrodt Institute of Radiology, St. Louis, MO.)

Fig. 4—179. Subcapsular liver metastases from ovarian carcinoma.

Large lesions involve the liver.

(Courtesy of Jay Heiken, M.D., Mallinckrodt Institute of Radiology, St. Louis, MO.)

liver metastases may present a characteristic "claw" sign (Fig. 4—178), analogous to that seen in superficial renal cysts, or a biconvex lens shape (Fig. 4—180).

Essentials of Human Physiology

Essentials of Human Physiology

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