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Findings: Extensive, loculated fluid collections are seen in a subcapsular location around the liver, superior recess of the lesser sac, mesentery and pelvis. No solid masses are identified, and no RLQ mass is identified. The patient is s/p hysterectomy.

Diagnosis: Pseudomyxoma Peritoneii from cystadenocarcinoma of the ovary.

Discussion: Pseudomyxoma peritoneii is a rarely identified entity seen secondary to extensive neoplastic mucin deposition throughout the peritoneal cavity. The two most common malignancies associated with pseudomyxoma peritoneii are cystadenocarcinoma of the ovary and mucinous tumors of the appendix. There are reports describing pseudomyxoma peritonei from urachal and uterine neoplasms. These tumors tend to be slowly growing, with minimal initial symptoms. As intraabdominal mucin deposition progresses, symptoms of bloating and bowel obstruction progress.

CT reports have described two primary manifestations of pseudomyxoma peritonei. As seen in this patient, one form presents as multiloculated collections throughout the abdomen. focal collections are seen a variety of peritoneal spaces, particularly the subhepatic/subcapsular space and the recesses of the lesser sac. In the second form, there is diffuse ascites, often causing mass effect on surrounding bowel loops. In patients treated with chemotherapy, these collections often resolve with residual punctate calcifications throughout the peritoneal recesses.

References:
Megibow, et al: Ovarian metastasis. Computed tomographic appearances.
Radiology:156:161, 1985.

Haaga J, Lanzieri C, et al. CT and MRI of the Whole Body. Mosby, 1994.

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