Diagnostic Ultrasound - Abdomen and Pelvis
Peritoneal Space Abscess (Left) Transverse ultrasound of the pelvis in a diabetic woman postdilatation and curettage is shown. A thick-walled abscess is present in the cul-de-sac ſt, posterior to the bladder . (Right) CECT of the same patient confirms the thickwalled abscess ſt. The bladder is empty. Diagnoses: Abdominal Wall/Peritoneal Cavity (Left) Longitudinal ultrasound of the midline pelvis in a patient with a renal transplant and a diverticular abscess ſt is shown. The fat between the abscess and the bladder is inflamed. (Right) Coronal NECT of the same patient shows the abscess ſt between the renal transplant and the bladder . Inflammatory fat stranding st is easier to recognize on NECT. (Left) Transverse ultrasound of the left pelvis in a child post recent surgery for complicated appendicitis shows a unilocular fluid collection ſt with internal echoes. (Right) CECT of the same patient confirms the collection but is superior at depicting the thick enhancing wall ſt and adjacent structures. 637
Segmental Omental Infarction Diagnoses: Abdominal Wall/Peritoneal Cavity TERMINOLOGY • Vascular compromise of greater omentum (may be primary or secondary) IMAGING • Noncompressible focal echogenic fat at site of maximal tenderness • CECT demonstrates focal fat haziness or, more commonly, a large (> 5 cm) nonenhancing heterogeneous omental mass with fat stranding • Central dot sign may be present (central echogenic/hyperattenuating focus representing central engorged or thrombosed vessel/hemorrhage) TOP DIFFERENTIAL DIAGNOSES • Acute appendicitis • Acute cholecystitis • Right-sided diverticulitis • Epiploic appendagitis KEY FACTS PATHOLOGY • Primary OI may result from venous channel kinking or omental torsion (resulting in vascular compromise) • Secondary OI may result from torsion due to: (a) attachment to an acquired lesion (e.g., surgical scar and neoplasm), (b) trauma, or (c) hernial incarceration CLINICAL ISSUES • Typical radiological appearances are diagnostic and management is conservative DIAGNOSTIC CHECKLIST • Typical cross-sectional appearances with normal appearances to adjacent structures • Absence of symptoms and signs of sepsis • Differentiate from more common causes of acute abdominal pain (especially acute appendicitis and acute cholecystitis) • Most common in right side of abdomen (Left) Transabdominal ultrasound of the right upper quadrant in a patient presenting with acute rightsided upper abdominal pain shows an echogenic elliptical mass deep to the anterior abdominal wall . The adjacent gallbladder appeared normal (not shown). (Right) Axial CECT of the same patient shows haziness to the omental fat in the right upper quadrant corresponding to the ultrasound abnormality. Note the adjacent thin-walled, normal-appearing gallbladder. (Left) Coronal MPR from the same patient shows omental fat with haziness giving a mass-like appearance. Note the normal thin-walled gallbladder. (Right) Follow-up study after 3 months shows interval improvement with slow resolution of the radiological changes. 638
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Peritoneal Space Abscess<br />
(Left) Transverse ultrasound of<br />
the pelvis in a diabetic woman<br />
postdilatation <strong>and</strong> curettage is<br />
shown. A thick-walled abscess<br />
is present in the cul-de-sac ſt,<br />
posterior to the bladder .<br />
(Right) CECT of the same<br />
patient confirms the thickwalled<br />
abscess ſt. The<br />
bladder is empty.<br />
Diagnoses: Abdominal Wall/Peritoneal Cavity<br />
(Left) Longitudinal ultrasound<br />
of the midline pelvis in a<br />
patient with a renal transplant<br />
<strong>and</strong> a diverticular abscess ſt<br />
is shown. The fat between the<br />
abscess <strong>and</strong> the bladder is<br />
inflamed. (Right) Coronal<br />
NECT of the same patient<br />
shows the abscess ſt between<br />
the renal transplant <strong>and</strong><br />
the bladder . Inflammatory<br />
fat str<strong>and</strong>ing st is easier to<br />
recognize on NECT.<br />
(Left) Transverse ultrasound of<br />
the left pelvis in a child post<br />
recent surgery for complicated<br />
appendicitis shows a<br />
unilocular fluid collection ſt<br />
with internal echoes. (Right)<br />
CECT of the same patient<br />
confirms the collection but is<br />
superior at depicting the thick<br />
enhancing wall ſt <strong>and</strong><br />
adjacent structures.<br />
637