#WetreadCoW Case 11 Answer: Pseudomyxoma Peritonei
-accumulation of mucinous ascites from mucin producing tumor. This case is the classic mucinous appendiceal tumor s/p multiple debulking surgeries! #FOAMed#FOAMrad#Radres#bodyrad
Rupture➡️ mucin & neoplastic cells into the peritoneum ➡️ diffuse peritoneal spread of malignancy and increasing abdominal distention
Pseudomyxoma Peritonei (Imaging)
US - echogenic peritoneal masses
CT - low/simple fluid locules w mass effect
+/- ring calcs
➡️ scalloping of organ surfaces
- often with curvilinear Calcs
- centrally displaced small bowel
MR - low T1, high T2 (follows water) +/- enhance
Pseudomyxoma Peritonei
Complication: fibrosis + adhesions➡️recurrent bowel obstructions (can be fatal)
-seroneg spondyloarthropathy (neg Rheum factor) ➡️ fusion of the spine, SI jts, pubic symphsysis, and sometimes other jts
- assoc w HLA B27 gene
-M>F
-usually presents 3rd-4th decade
-trt: NSAIDS, motion/exercise, TNF-alpha blockers
#WetreadCoW Case 8 Answer: Hepatic Adenoma w hemorrhage
Multiple hyperenhancing hepatic masses in a young female. Largest in L lobe w hyperdensity (blood)➡️irreg contour w mild extracapsular hemorrhage #FOAMrad#radres#bodyrad#ERrad
Hepatic Adenomas:
-Benign
-m/c hepatic tumor in young females classically on OCPs
-stimulated by estrogen (OCPs, obesity, anabolic steroid use)
-typically asymptomatic
-prone to hemorrhage even➡️exsanguination!