DOI: 10.1148/rg.253045145
Unusual Nonneoplastic Peritoneal and Subperitoneal Conditions: CT Findings1
Perry J. Pickhardt, MD and
Sanjeev Bhalla, MD
1 From the Department of Radiology, University of Wisconsin Medical School, Madison (P.J.P.); the Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (P.J.P.); and the Mallinckrodt Institute of Radiology, St Louis, Mo (S.B.). Recipient of a Certificate of Merit award for an education exhibit at the 2003 RSNA Scientific Assembly. Received July 9, 2004; revision requested August 18 and received September 23; accepted September 27. P.P. is a medical consultant for Viatronix, Inc; S.B. has no financial relationships to disclose.
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Figure 1. Peritoneal and subperitoneal spaces. Sagittal diagram shows the relationship of the peritoneal cavity (purple) to the peritoneal lining and subperitoneal space (yellow). Note the continuity between the intraperitoneal and extraperitoneal components of the subperitoneal space.
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Figure 2a. Eosinophilic peritonitis in a symptomatic 55-year-old man with unexplained intractable ascites. Axial contrast-enhanced CT images show soft-tissue infiltration predominantly involving the omentum (arrowheads) with lesser involvement of other peritoneal ligaments, mesenteries, and the parietal peritoneum. Eosinophilic ascites is also present (* in b). No mucosal abnormality was seen at panendoscopy, but peripheral eosinophilia was present. The diagnosis was confirmed with omental biopsy.
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Figure 2b. Eosinophilic peritonitis in a symptomatic 55-year-old man with unexplained intractable ascites. Axial contrast-enhanced CT images show soft-tissue infiltration predominantly involving the omentum (arrowheads) with lesser involvement of other peritoneal ligaments, mesenteries, and the parietal peritoneum. Eosinophilic ascites is also present (* in b). No mucosal abnormality was seen at panendoscopy, but peripheral eosinophilia was present. The diagnosis was confirmed with omental biopsy.
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Figure 3a. Primary systemic amyloidosis in an asymptomatic 73-year-old man. He had received chemotherapy and radiation therapy for symptomatic thoracic disease but had not had significant abdominal symptoms. Axial contrast-enhanced CT images (a obtained at a higher level than b) show multifocal mesenteric masses containing areas of dystrophic calcification. The size of the soft-tissue lesions had increased only slightly compared with that on previously obtained CT images over a period of 5 years.
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Figure 3b. Primary systemic amyloidosis in an asymptomatic 73-year-old man. He had received chemotherapy and radiation therapy for symptomatic thoracic disease but had not had significant abdominal symptoms. Axial contrast-enhanced CT images (a obtained at a higher level than b) show multifocal mesenteric masses containing areas of dystrophic calcification. The size of the soft-tissue lesions had increased only slightly compared with that on previously obtained CT images over a period of 5 years.
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Figure 4. Advanced systemic amyloidosis in a 59-year-old man. Axial contrast-enhanced CT image shows extensive peritoneal soft-tissue infiltration and multifocal coarse calcifications.
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Figure 5a. Extramedullary hematopoiesis in an 81-year-old woman with myelofibrosis. Axial contrast-enhanced CT images (a obtained at a higher level than b) show bulky but soft mesenteric masses. Note the lack of significant mass effect on the bowel loops. The diagnosis was confirmed with CT-guided biopsy.
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Figure 5b. Extramedullary hematopoiesis in an 81-year-old woman with myelofibrosis. Axial contrast-enhanced CT images (a obtained at a higher level than b) show bulky but soft mesenteric masses. Note the lack of significant mass effect on the bowel loops. The diagnosis was confirmed with CT-guided biopsy.
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Figure 6. Peritoneal involvement in a 41-year-old man with known Erdheim-Chester disease and a long history of intermittent abdominal pain. Axial contrast-enhanced CT image shows soft-tissue infiltration predominantly involving the omentum (arrowheads).
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Figure 7. Peritoneal sarcoidosis in a 33-year-old woman with increased abdominal distention, nausea, and vomiting. Axial contrast-enhanced CT image shows ascites as well as mild but diffuse soft-tissue thickening involving the mesentery, omentum, and parietal peritoneum.
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Figure 8a. Mesenteric cavitary lymph node syndrome in an 83-year-old woman with a 3-month history of diarrhea and weight loss. Axial contrast-enhanced CT images (a obtained at a higher level than b) show enlarged mesenteric lymph nodes with characteristic fat-fluid levels (arrowheads). (Case courtesy of Denise Reddy, MD, Loyola University Medical Center, Maywood, Ill.)
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Figure 8b. Mesenteric cavitary lymph node syndrome in an 83-year-old woman with a 3-month history of diarrhea and weight loss. Axial contrast-enhanced CT images (a obtained at a higher level than b) show enlarged mesenteric lymph nodes with characteristic fat-fluid levels (arrowheads). (Case courtesy of Denise Reddy, MD, Loyola University Medical Center, Maywood, Ill.)
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Figure 9. Intraabdominal desmoid (fibromatosis) in a 36-year-old man with an abdominal mass that was increasing in size (and no history of FAPS). Axial contrast-enhanced CT image shows a solitary mesenteric mass with an irregular border (arrow).
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Figure 10. Intraabdominal desmoid (fibromatosis) in a 29-year-old woman with a history of early satiety (and no history of FAPS). Axial contrast-enhanced CT image shows a solitary mesenteric mass with a smooth border.
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Figure 11. Inflammatory pseudotumor in a teenage boy. Axial contrast-enhanced CT image shows the infiltrative soft-tissue appearance of peritoneal inflammatory pseudotumor (myofibroblastic tumor) (arrows).
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Figure 12. Inflammatory pseudotumor in a young girl. Axial contrast-enhanced CT image shows the tumorlike appearance of peritoneal inflammatory pseudotumor (myofibroblastic tumor).
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Figure 13. Retractile mesenteritis in a 54-year-old man with a long history of abdominal pain. Axial contrast-enhanced CT image shows a densely calcified, spiculated mesenteric mass (*). The CT appearance resembles that of metastatic carcinoid.
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Figure 14. Castleman disease in a 31-year-old man with a history of fever. Axial contrast-enhanced CT image shows lymphadenopathy limited to the gastrosplenic region (arrow). This finding proved to represent Castleman disease.
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Figure 15. Castleman disease complicated by non-Hodgkin lymphoma in an elderly man. Axial contrast-enhanced CT image shows confluent mesenteric and retroperitoneal lymphadenopathy.
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Figure 16. Tuberculous peritonitis in a 47-year-old man without evidence of thoracic disease. Axial contrast-enhanced CT image shows the "dry" form of peritoneal tuberculosis, which consists of diffuse fibrous thickening of the peritoneal lining without ascites.
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Figure 17. Tuberculous peritonitis in a 39-year-old man with weight loss and fever. Axial contrast-enhanced CT image shows prominent low-attenuation mesenteric lymphadenopathy.
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Figure 18. Actinomycosis associated with an IUD in a 49-year-old woman. Axial contrast-enhanced CT image shows a complex solid (arrowheads) and cystic adnexal process, which proved to be actinomycosis. Arrow = IUD.
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Figure 19. Peritoneal echinococcosis in a patient who previously had hepatic hydatid disease. Axial contrast-enhanced CT image shows a complex cystic peritoneal lesion with thick eccentric calcification (arrowheads).
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Figure 20. Whipple disease in a 38-year-old man with diarrhea and abdominal pain. Axial contrast-enhanced CT image shows mesenteric lymphadenopathy with a mixed soft-tissue and fatty appearance (arrowheads). Mild thickening of the small bowel wall was present at other levels.
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Figure 21. Mesenteric adenitis in a 22-year-old man with acute right lower quadrant pain. Axial unenhanced CT image shows multiple ileocecal nodes greater than 5 mm in diameter adjacent to a normal, air-filled appendix.
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Figure 22. Epiploic appendagitis in a 28-year-old woman with acute left lower quadrant pain. Axial contrast-enhanced CT image shows soft-tissue infiltration in and around a fatty appendage (arrow) extending off the sigmoid colon.
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Figure 23. Chronic (old) epiploic appendagitis in an asymptomatic 52-year-old man undergoing screening virtual colonoscopy. Axial unenhanced CT image shows an appendage with dystrophic calcification (arrow), which is evidence of prior appendagitis.
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Figure 24. Mesenteric panniculitis in a 28-year-old man with vague abdominal symptoms. Axial contrast-enhanced CT image shows mesenteric soft-tissue infiltration that is characteristically localized to a jejunal segment, spares the perivascular fat, and has a pseudo-capsule appearance.
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Figure 25. Mesenteric panniculitis in a 32-year-old woman with abdominal pain but no fever. Coronal contrast-enhanced CT image shows hazy soft-tissue infiltration of the mesentery.
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Figure 26. Segmental omental infarction in a 40-year-old man with acute right-sided abdominal pain. Axial contrast-enhanced CT image shows localized soft-tissue infiltration (arrowhead), which represents a subtle example of right-sided omental infarction.
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Figure 27. Segmental omental infarction in a 42-year-old man with acute right lower quadrant pain. Axial contrast-enhanced CT image shows a localized masslike process (arrowhead), which represents a more advanced example of right-sided omental infarction.
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Copyright © 2005 by the Radiological Society of North America.
