Radiologic evaluation of peritoneal carcinomatosis

Radiologic changes in plain abdominal films as well as barium contrast studies of small and large bowels are reviewed in pathologically proven 53 cases of peritoneal carcinomatosis at Severance Hospital during last five years. A study of these patients reveals multiplicity of roentgen findings which, though not pathognomic, may be highly diagnostic. The common distinctive features are broad-based nodular filling defects along the mesenteric border, no overhanging edge and fixed transverse or radiating, angulated or crowded mucosal folds with restricted distensibility and extensibility and the most important, the absence of the mucosal ulceration until the late stage. When the lesion ulcerates or becomes circumferential, the differential from the intestinal tuberculosis and primary carcinoma may be impossible. Another characteristic findings to exclude primary carcinoma from presenting Blummer's shelf is displacement and indentation the anterior aspect of the rectum with preservation of the presacral space. And also serosal changes in midportion of transverse and/or superior border of sigmoid colon associated with ascites may be highly suggestive of peritoneal carcinomatosis.