Tuesday, October 19, 2010

Cause of Ascites?

Think this is an interesting CT scan of abdomen.

A lady was admitted to medical for "Ascites for invesigation" - as usual, everything under the sun will be "for medical to find out". She complained of progressive abdominal distension and discomfort, and there was a vague mass felt on abdominal palpation.

What do you think the CT (circled area) shows? (You can click to enlarge)

10 comments:

-hui- said...

cysticercus cellulosae? lol.

shay said...

Quoting my friend:

This patient might not be in the right place.. she should be in general surg ward.

Though this is really wild - ectopic pregnancy with implantation at mesentery/small intestine.

Darren Lee said...

hui: Cysticercus cellulosae affecting more of muscles and CNS right? But wow tat's a cool diagnosis - I guess you're doing pathology/ parisitology sem now hehe=)

shay: You're right that she's in the wrong ward - she should be in gyne ward actually - but it's not ectopic preg. Anymore guess?

shay said...

Demand a further hx:
Patient's detail
Age

Progression of 'ascites' how long how fast

Menstrual, Sexual Past Medical hx.

Any Liver disease? Renal Disease?

Patient social background

FBC, LFT, Urea Creatinine and Electrolyte, bHCG please. INR APTT.

Thanks :P.

shay said...

My guess -

Ovarian cancer. with intraperitoneum spread.

Darren Lee said...

shay:
Excellent! Yes she has an ovarian Ca which spreads to the omentum. There's a name for the classical CT appearance, do you know? ;)

-hui- said...

yah.. but it kinda looks like it.. lol. oh well.. too much of parasitolgy i think.

shay said...

I only know the omental cake appearance in surgery. Is that the radiological description?

Darren Lee said...

shay:
Yup that's the answer!
The scan shows a grossly abnormal and thickened omentum, giving the appearance of an "Omental cake".

Differential diagnoses of omental cakes:

Malignancy: Ovarian, gastric, colonic, lymphoma etc

Inflammatory: TB, Crohn's disease

Benign: Sclerosing mesenteritis, desmoid fibroma

This lady had an ovarian Ca. She was then taken over by gyne team.

Teoh said...

Surprised that a vague mass palpable per abdomen didn't land up in my ward...casualty nowadays have this problem of admitting the wrong patient to the wrong ward.

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