Imaging Pearls ❯ Colon ❯ Omentum
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- Omental Infarct: Facts
- Much more common than usually realized
- “Primary” type is ~ always adjacent to ascending colon
- “Big ball of dirty fat” (~3-8 cm in diameter)
- Often encapsulated
- May show twisted omental vessels
- Minimal or no inflammation of colon - Epiploic Appendagitis: Facts
- Less common on right side than left
- Usually near descending + sigmoid colon
- “Little ball of dirty fat” (~2-4 cm)
- Central dot = occluded vein
- Usually has thin capsule
- Peritoneal Calcification: Causes
- Dialysis
- Prior peritonitis
- Ovarian cancer
- Tuberculosis
- Extravasated barium
- Post surgical heterotopic calcification - “Pseudomyxoma peritonei (PMP) first described by Werth is an uncommon and poorly understood disease characterized by abundant extracellular mucin in the peritoneum. The "myxomatous" appearance is attributed to the associated fibroblastic and vascular proliferation that is probably incited by the mucin. This results in multifocal peritoneal, serosal and ommental implants admixed with copious amounts of mucin accumulation within the abdomen and pelvis resulting in the belly full of jelly – "the jelly belly”.”
Pseudomyxoma Peritonei-a revisit
Li C et al
World J Surg Oncol 2006:4:60 - “A definitive diagnosis of PMP requires the presence of a) mucinous neoplastic cells/epithelium, and b) mucinous ascites – diffuse intraabdominal mucin. Some authors also require the presence of diffuse mucinous implants for this diagnosis. Viable epithelial glandular cells must be identified within the mucin pools by histological analysis to diagnose PMP. Cases without epithelium are regarded as mucinous ascites.”
Pseudomyxoma Peritonei-a revisit
Li C et al
World J Surg Oncol 2006:4:60 - “Pseudomyxoma peritonei is an indolent disease and preferentially affects women with an average age of 53 years [4]. It is traditionally believed that most cases of PMP originate from ovarian tumors. This belief is challenged recently by increased usage of immunohistochemical stains and molecular genetic studies, which showed a large proportion of these tumors to be secondary to appendiceal tumors in both men and women .”
Pseudomyxoma Peritonei-a revisit
Li C et al
World J Surg Oncol 2006:4:60
- Omental Infarction : Key Facts
- Infarcted fatty tissue in omentum
- Area of inflammation larger than with appendix epiploicae
- Treated conservatively - Omental Infarction : Facts
- Usually presents as RLQ or upper quadrant pain
- May affect younger patients including teenagers
- May be a sequelae of trauma, strenuous activity or recent abdominal surgery - Omental Infarction vs Acute Epiploic Appendagitis :Facts
- Larger area of involvement with omental infarction (>5cm)
- Omental infarction more common right colon or cecum
- No discrete nodule with omental infarction