case studies

Abdomen

Patient History
A Patient presented with a paraumbilical hernia repair, mucoid tissue present ? pseudomyxoma peritonei.

Methodology
The patient was scanned in the supine position with the scan field from top of diaphragm to the symphasis pubis. The patient was prepared with oral Gastrographin the night prior to the scan, 1.5 hours and immediately before the scan. The patient was injected with 100mls of Omnipaque 300, with the scan timed to start 65secs after the injection started. A pump injector was used to ensure accurate timing of contrast administration at 3ml/second, the delay providing good enhancement of the liver in portal venous stage.

The scan was performed as a volume scan with 10mm slice thickness on a pitch of 1.5, mA of 200, KV 120, 50cm field of view, with a standard algorithm and no sharpness enhancement.

Report
The liver enhances uniformly with no evidence of space occupying lesions. No intra-hepatic duct dilation is seen (fig 1) The spleen, pancreas, supra-renals, kidneys and aorta + IVC appear normal (figs 1 and 2). Ascites in the peritoneal cavity (fig 1) and multiple peritoneal deposits throughout the parietal, peritoneum and serosa of small and large bowel. There is a large mass (soft tissue) seen in pouch of douglas (figs 3 & 4). No definite lymphadenopathy or calcifications is seen. Features are those of pseudomyxoma peritonei.

Conclusion
Oral contrast gives good 'GI' enhancement, intravenous contrast media gives good liver, kidney and soft tissue structure enhancement. CT of the abdomen is relatively non-invasive and fast imaging modality.

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