CT in pseudomyxoma peritonei: a review of 17 cases.

Objective: To describe the computed tomography (CT) findings in pseudomyxoma peritonei.

Methods: Two observers independently and retrospectively reviewed the CT images of 17 consecutive patients (nine women, eight men, mean age 53 years) with histologically proven pseudomyxoma peritonei.

Results: Six patients had small volume disease where pseudomyxoma peritonei was present in focal collections in the peritoneal cavity. Eleven had large volume disease that completely, or almost completely, filled the peritoneal cavity. Pseudomyxoma peritonei is characterized by low attenuation mucinous ascites on CT. Areas of high attenuation, septae and calcification are seen more commonly within it as the volume of disease increases. The pattern of accumulation of pseudomyxoma peritonei follows the normal flow of peritoneal fluid. It initially seeds at sites of relative stasis and as large volume disease develops it fills the remaining spaces in the peritoneal cavity and pressure effects dominate imaging. Pseudomyxoma peritonei may extend into hernial orifices or the pleural cavity.

Conclusions: Pseudomyxoma peritonei is difficult to diagnose clinically. However, the pattern of accumulation of disease is predictable and can be recognized on CT.