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Primary and secondary disease of the peritoneum and mesentery: review of anatomy and imaging features

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Abstract

The largest and most complex serosal membrane in the body, the peritoneum, lines the abdominal cavity, and the abdominopelvic viscera. It is frequently involved in a variety of benign and malignant processes. While secondary involvement of the peritoneum is more common, primary tumors can be a diagnostic challenge. Knowledge of the anatomy is crucial in understanding the various pathologic processes. Cross-sectional imaging plays an important role in diagnosing and evaluating the extent of the disease processes. This article reviews the imaging anatomy of the peritoneum and mesentery and the common pathologies involving it.

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References

  1. Levy AD, Arnáiz J, Shaw JC, et al. (2008) From the archives of the AFIP: primary peritoneal tumors: imaging features with pathologic correlation. Radiographics 28(2):583–607 (; quiz 621–2)

    Article  PubMed  Google Scholar 

  2. Levy AD, Shaw JC, Sobin LH (2009) Secondary tumors and tumorlike lesions of the peritoneal cavity: imaging features with pathologic correlation. Radiographics 29(2):347–373

    Article  PubMed  Google Scholar 

  3. Feldman GB, Knapp RC (1974) Lymphatic drainage of the peritoneal cavity and its significance in ovarian cancer. Am J Obstet Gynecol 119(7):991–994

    CAS  PubMed  Google Scholar 

  4. Healy JC, Reznek RH (1998) The peritoneum, mesenteries and omenta: normal anatomy and pathological processes. Eur Radiol 8(6):886–900

    Article  CAS  PubMed  Google Scholar 

  5. Dodds WJ, Foley WD, Lawson TL, et al. (1985) Anatomy and imaging of the lesser peritoneal sac. AJR Am J Roentgenol 144(3):567–575

    Article  CAS  PubMed  Google Scholar 

  6. Sompayrac SW, Mindelzun RE, Silverman PM, et al. (1997) The greater omentum. AJR Am J Roentgenol 168(3):683–687

    Article  CAS  PubMed  Google Scholar 

  7. Yoo E, Kim JH, Kim MJ, et al. (2007) Greater and lesser omenta: normal anatomy and pathologic processes. Radiographics 27(3):707–720

    Article  PubMed  Google Scholar 

  8. Jeffrey RB, Federle MP, Goodman PC (1981) Computed tomography of the lesser peritoneal sac. Radiology 141(1):117–122

    Article  CAS  PubMed  Google Scholar 

  9. Zhao Z, Liu S, Li Z, et al. (2005) Sectional anatomy of the peritoneal reflections of the upper abdomen in the coronal plane. J Comput Assist Tomogr 29(4):430–437

    Article  PubMed  Google Scholar 

  10. Meyers MA, Oliphant M, Berne AS, et al. (1987) The peritoneal ligaments and mesenteries: pathways of intraabdominal spread of disease. Radiology 163(3):593–604

    Article  CAS  PubMed  Google Scholar 

  11. Rubenstein WA, Auh YH, Whalen JP, et al. (1983) The perihepatic spaces: computed tomographic and ultrasound imaging. Radiology 149(1):231–239

    Article  CAS  PubMed  Google Scholar 

  12. Meyers MA (1970) Roentgen significance of the phrenicocolic ligament. Radiology 95(3):539–545

    Article  CAS  PubMed  Google Scholar 

  13. Akram S, Pardi DS, Schaffner JA, Smyrk TC (2007) Sclerosing mesenteritis: clinical features, treatment, and outcome in ninety-two patients. Clin Gastroenterol Hepatol 5(5):589–596

    Article  PubMed  Google Scholar 

  14. Levy AD, Patel N, Dow N, et al. (2006) From the archives of the AFIP: benign fibrous tumors and tumorlike lesions of the mesentery: radiologic-pathologic correlation. Radiographics 26(1):245–264

    Article  PubMed  Google Scholar 

  15. Horton KM, Lawler LP, Fishman EK (2003) CT findings in sclerosing mesenteritis (panniculitis): spectrum of disease. Radiographics 23(6):1561–1567

    Article  PubMed  Google Scholar 

  16. Valls C (2000) Fat-ring sign in sclerosing mesenteritis. AJR Am J Roentgenol 174(1):259–260

    Article  CAS  PubMed  Google Scholar 

  17. Kobayashi S, Takeda K, Tanaka N, et al. (1993) Mesenteric panniculitis: MR findings. J Comput Assist Tomogr 17(3):500–502

    Article  CAS  PubMed  Google Scholar 

  18. Singh AK, Gervais DA, Lee P, et al. (2006) Omental infarct: CT imaging features. Abdom Imaging 31(5):549–554

    Article  CAS  PubMed  Google Scholar 

  19. Hollerweger A, Rettenbacher T, Macheiner P, et al. (1996) Spontaneous fatty tissue necrosis of the omentum majus and epiploic appendices: clinical, ultrasonic and CT findings. Rofo 165(6):529–534

    Article  CAS  PubMed  Google Scholar 

  20. Singh AK, Gervais DA, Lee P, et al. (2004) CT appearance of acute appendagitis. AJR Am J Roentgenol 183(5):1303–1307

    Article  PubMed  Google Scholar 

  21. Kamisawa T, Imai M, Chen PY, et al. (2010) Autoimmune pancreatitis and IgG4-related sclerosing disease. Nat Rev Gastroenterol Hepatol 7(7):401–409

    Article  CAS  PubMed  Google Scholar 

  22. Patnana M, Sevrukov AB, Elsayes KM, et al. (2012) Inflammatory pseudotumor: the great mimicker. AJR Am J Roentgenol 198(3):W217–W227

    Article  PubMed  Google Scholar 

  23. Levy AD, Cantisani V, Miettinen M (2004) Abdominal lymphangiomas: imaging features with pathologic correlation. AJR Am J Roentgenol 182(6):1485–1491

    Article  PubMed  Google Scholar 

  24. Lugo-Olivieri CH, Taylor GA (1993) CT differentiation of large abdominal lymphangioma from ascites. Pediatr Radiol 23(2):129–130

    Article  CAS  PubMed  Google Scholar 

  25. Ha HK, Jung JI, Lee MS, et al. (1996) CT differentiation of tuberculous peritonitis and peritoneal carcinomatosis. AJR Am J Roentgenol 167(3):743–748

    Article  CAS  PubMed  Google Scholar 

  26. Epstein BM, Mann JH (1982) CT of abdominal tuberculosis. AJR Am J Roentgenol 139(5):861–866

    Article  CAS  PubMed  Google Scholar 

  27. Alterman DD, Cho KC (1988) Histoplasmosis involving the omentum in an AIDS patient: CT demonstration. J Comput Assist Tomogr 12(4):664–665

    Article  CAS  PubMed  Google Scholar 

  28. Kawaguchi Y, Saito A, Kawanishi H, et al. (2005) Recommendations on the management of encapsulating peritoneal sclerosis in Japan, 2005: diagnosis, predictive markers, treatment, and preventive measures. Perit Dial Int 25(Suppl 4):S83–S95

    PubMed  Google Scholar 

  29. Ti JP, Al-Aradi A, Conlon PJ, et al. (2010) Imaging features of encapsulating peritoneal sclerosis in continuous ambulatory peritoneal dialysis patients. AJR Am J Roentgenol 195(1):W50–W54

    Article  PubMed  Google Scholar 

  30. Fleming CR, Dickson ER, Harrison EG Jr (1976) Splenosis: autotransplantation of splenic tissue. Am J Med 61(3):414–419

    Article  CAS  PubMed  Google Scholar 

  31. Alvarez R, Diehl KM, Avram A, et al. (2007) Localization of splenosis using 99mTc-damaged red blood cell SPECT/CT and intraoperative gamma probe measurements. Eur J Nucl Med Mol Imaging 34(6):969

    Article  PubMed  Google Scholar 

  32. Bazot M, Daraï E, Hourani R, et al. (2004) Deep pelvic endometriosis: MR imaging for diagnosis and prediction of extension of disease. Radiology 232(2):379–389

    Article  PubMed  Google Scholar 

  33. Ascher SM, Agrawal R, Bis KG, et al. (1995) Endometriosis: appearance and detection with conventional and contrast-enhanced fat-suppressed spin-echo techniques. J Magn Reson Imaging 5(3):251–257

    Article  CAS  PubMed  Google Scholar 

  34. Muller AM, Söndgen D, Strunz R, Müller KM (2002) Gliomatosis peritonei: a report of two cases and review of the literature. Eur J Obstet Gynecol Reprod Biol 100(2):213–222

    Article  PubMed  Google Scholar 

  35. Ferguson AW, Katabuchi H, Ronnett BM, et al. (2001) Glial implants in gliomatosis peritonei arise from normal tissue, not from the associated teratoma. Am J Pathol 159(1):51–55

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  36. Hill DA, Dehner LP, White FV, et al. (2000) Gliomatosis peritonei as a complication of a ventriculoperitoneal shunt: case report and review of the literature. J Pediatr Surg 35(3):497–499

    Article  CAS  PubMed  Google Scholar 

  37. Mengshol SC, Demars LR, Schned AR (2004) Gliomatosis peritonei and teratomatous implant with carcinomatous transformation presenting 54 years following oophorectomy for dermoid cyst. Gynecol Oncol 92(1):353–356

    Article  PubMed  Google Scholar 

  38. England RA, deSouza NM, Kaye SB (2007) Gliomatosis peritonei: MRI appearances and its potential role in follow up. Br J Radiol 80(953):e101–e104

    Article  CAS  PubMed  Google Scholar 

  39. Jain KA (2000) Imaging of peritoneal inclusion cysts. AJR Am J Roentgenol 174(6):1559–1563

    Article  CAS  PubMed  Google Scholar 

  40. Moyle PL, Kataoka MY, Nakai A, et al. (2010) Nonovarian cystic lesions of the pelvis. Radiographics 30(4):921–938

    Article  PubMed  Google Scholar 

  41. Attanoos RL, Gibbs AR (1997) Pathology of malignant mesothelioma. Histopathology 30(5):403–418

    Article  CAS  PubMed  Google Scholar 

  42. Busch JM, Kruskal JB, Wu B (2002) Best cases from the AFIP. Malignant peritoneal mesothelioma. Radiographics 22(6):1511–1515

    Article  PubMed  Google Scholar 

  43. Guest PJ, Reznek RH, Selleslag D, et al. (1992) Peritoneal mesothelioma: the role of computed tomography in diagnosis and follow up. Clin Radiol 45(2):79–84

    Article  CAS  PubMed  Google Scholar 

  44. Chiou SY, Sheu MH, Wang JH, et al. (2003) Peritoneal serous papillary carcinoma: a reappraisal of CT imaging features and literature review. Abdom Imaging 28(6):815–819

    Article  CAS  PubMed  Google Scholar 

  45. Sagar PM, Moslein G, Dozois RR (1998) Management of desmoid tumors in patients after ileal pouch-anal anastomosis for familial adenomatous polyposis. Dis Colon Rectum 41(11):1350–1355 (discussion 1355–1356)

    Article  CAS  PubMed  Google Scholar 

  46. Burke AP, Sobin LH, Shekitka KM, et al. (1990) Intra-abdominal fibromatosis. A pathologic analysis of 130 tumors with comparison of clinical subgroups. Am J Surg Pathol 14(4):335–341

    Article  CAS  PubMed  Google Scholar 

  47. Goodlad JR, Fletcher CD (1991) Solitary fibrous tumour arising at unusual sites: analysis of a series. Histopathology 19(6):515–522

    Article  CAS  PubMed  Google Scholar 

  48. Young RH, Clement PB, McCaughey WT (1990) Solitary fibrous tumors (‘fibrous mesotheliomas’) of the peritoneum. A report of three cases and a review of the literature. Arch Pathol Lab Med 114(5):493–495

    CAS  PubMed  Google Scholar 

  49. Pickhardt PJ, Fisher AJ, Balfe DM, et al. (1999) Desmoplastic small round cell tumor of the abdomen: radiologic–histopathologic correlation. Radiology 210(3):633–638

    Article  CAS  PubMed  Google Scholar 

  50. Tateishi U, Hasegawa T, Kusumoto M, et al. (2002) Desmoplastic small round cell tumor: imaging findings associated with clinicopathologic features. J Comput Assist Tomogr 26(4):579–583

    Article  PubMed  Google Scholar 

  51. Raptopoulos V, Gourtsoyiannis N (2001) Peritoneal carcinomatosis. Eur Radiol 11(11):2195–2206

    Article  CAS  PubMed  Google Scholar 

  52. McLaughlin PD, Filippone A, Maher MM (2013) Neoplastic diseases of the peritoneum and mesentery. AJR Am J Roentgenol 200(5):W420–W430

    Article  PubMed  Google Scholar 

  53. Marin D, Catalano C, Baski M, et al. (2010) 64-section multi-detector row CT in the preoperative diagnosis of peritoneal carcinomatosis: correlation with histopathological findings. Abdom Imaging 35(6):694–700

    Article  PubMed  Google Scholar 

  54. Pannu HK, Horton KM, Fishman EK (2003) Thin section dual-phase multidetector-row computed tomography detection of peritoneal metastases in gynecologic cancers. J Comput Assist Tomogr 27(3):333–340

    Article  PubMed  Google Scholar 

  55. Franiel T, Diederichs G, Engelken F, et al. (2009) Multi-detector CT in peritoneal carcinomatosis: diagnostic role of thin slices and multiplanar reconstructions. Abdom Imaging 34(1):49–54

    Article  PubMed  Google Scholar 

  56. Fujii S, Matsusue E, Kanasaki Y, et al. (2008) Detection of peritoneal dissemination in gynecological malignancy: evaluation by diffusion-weighted MR imaging. Eur Radiol 18(1):18–23

    Article  PubMed  Google Scholar 

  57. Low RN, Gurney J (2009) Diffusion-weighted MRI of peritoneal tumors: comparison with conventional MRI and surgical and histopathologic findings—a feasibility study. AJR Am J Roentgenol 193(2):461–470

    Article  PubMed  Google Scholar 

  58. Low RN (2007) MR imaging of the peritoneal spread of malignancy. Abdom Imaging 32(3):267–283

    Article  PubMed  Google Scholar 

  59. Turlakow A, Yeung HW, Salmon AS, et al. (2003) Peritoneal carcinomatosis: role of (18)F-FDG PET. J Nucl Med 44(9):1407–1412

    PubMed  Google Scholar 

  60. Chua TC, Al-Zahrani A, Saxena A, et al. (2011) Determining the association between preoperative computed tomography findings and postoperative outcomes after cytoreductive surgery and perioperative intraperitoneal chemotherapy for pseudomyxoma peritonei. Ann Surg Oncol 18(6):1582–1589

    Article  PubMed  Google Scholar 

  61. Pestieau SR, Esquivel J, Sugarbaker PH (2000) Pleural extension of mucinous tumor in patients with pseudomyxoma peritonei syndrome. Ann Surg Oncol 7(3):199–203

    Article  CAS  PubMed  Google Scholar 

  62. Bechtold RE, Dyer RB, Zagoria RI, et al. (2001) CT appearance of disseminated peritoneal adenomucinosis. Abdom Imaging 26(4):406–410

    Article  CAS  PubMed  Google Scholar 

  63. Ferrozzi F, Tognini G, Mulonzia NW, et al. (2001) Primary effusion lymphomas in AIDS: CT findings in two cases. Eur Radiol 11(4):623–625

    Article  CAS  PubMed  Google Scholar 

  64. Burke AP, Thomas RM, Elsayed AM, et al. (1997) Carcinoids of the jejunum and ileum: an immunohistochemical and clinicopathologic study of 167 cases. Cancer 79(6):1086–1093

    Article  CAS  PubMed  Google Scholar 

  65. Sheth S, Horton KM, Garland MR, et al. (2003) Mesenteric neoplasms: CT appearances of primary and secondary tumors and differential diagnosis. Radiographics 23(2):457–473 (; quiz 535–536)

    Article  PubMed  Google Scholar 

  66. Pantongrag-Brown L, Buetow PC, Carr NJ, et al. (1995) Calcification and fibrosis in mesenteric carcinoid tumor: CT findings and pathologic correlation. AJR Am J Roentgenol 164(2):387–391

    Article  CAS  PubMed  Google Scholar 

  67. Maroun J, Kocha W, Kvols L, et al. (2006) Guidelines for the diagnosis and management of carcinoid tumours. Part 1: the gastrointestinal tract. A statement from a Canadian National Carcinoid Expert Group. Curr Oncol 13(2):67–76

    PubMed Central  CAS  PubMed  Google Scholar 

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Acknowledgments

The authors acknowledge and thank Sarah Abate and Vanessa Allen, Radiology Media Division-University of Michigan Health System, for help with illustrations and image annotations.

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Authors and Affiliations

  1. Division of Abdominal Imaging, Department of Radiology, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA

    Ashish P. Wasnik, Katherine E. Maturen, Ravi K. Kaza, Mahmoud M. Al-Hawary & Isaac R. Francis

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  1. Ashish P. Wasnik
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  2. Katherine E. Maturen
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Correspondence to Ashish P. Wasnik.

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Wasnik, A.P., Maturen, K.E., Kaza, R.K. et al. Primary and secondary disease of the peritoneum and mesentery: review of anatomy and imaging features. Abdom Imaging 40, 626–642 (2015). https://doi.org/10.1007/s00261-014-0232-8

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