![]() Ībout 70% of patients with peritoneal carcinomatosis present with ascites. Occasionally, bowel or ureteral obstruction may occur. Typical findings indicating peritoneal carcinomatosis are ascites, omental and mesenteric infiltration, and scattered peritoneal nodules. Those barriers can be easily forced by a large amount of ascitic fluid. The falciform ligament prevents the mixture of the peritoneal fluid between the right and left subphrenic spaces. On the left, this upward movement is blocked by the phrenicocolic ligament. The fluid accumulated in pelvic recesses moves upward to the subphrenic compartment, preferen-tially via the deeper right paracolic gutter. The route of circulation of the peritoneal fluid explains the propensity of metastases to occupy certain peritoneal compartments. It enables frictionless movement of the viscera and mediates the exchange of substances and immune cells between the peritoneal cavity and the plasma. In healthy individuals, the peritoneal cavity contains 5-20 ml of serosal fluid, formed mostly from the plasma transudate and the ovarian exudate. The peritoneum provides mobility of the organs, enables fluid transport and peritoneal dialysis, and hosts immunocompetent cells. The visceral peritoneum partially or completely surrounds the viscera. The parietal peritoneum covers the diaphragm, lines the abdominal wall, and secretes peritoneal fluid. The peritoneal cavity is a potential space located between the parietal and the visceral peritoneum. Peritoneal cavity, peritoneal fluid, and pathways of its circulation The introduction of these therapeutic methods has significantly improved the life expectancy of patients with peritoneal carcinomatosis. The imaging findings may influence the surgeon’s decision on performing cytoreductive surgery, which may be followed by intraperitoneal chemotherapy (HIPEC or EPIC procedures). The Peritoneal Carcinomatosis Index (PCI) is a scale used to assess the tumour burden in the peritoneum and may serve as a communication tool between clinicians and radiologists. Some studies suggest that PET/CT may be the most sensitive method, yet its usefulness in everyday practice is controversial. The sensitivity of magnetic resonance imaging depends on the size of peritoneal implants – in cases of implants larger than 10 mm is comparable to CT. Computed tomography is the method of choice, due to its availability, cost-effectiveness, and relatively high sensitivity. Ultrasound has low sensitivity and specificity, and therefore plays only a marginal role. Several imaging modalities may be applied in patients with peritoneal carcinomatosis. The 3 most common imaging findings are ascites, nodular implants, and infiltration of the peritoneal fatty tissue. Peritoneal implants tend to locate in the areas of the physiological stasis of the peritoneal fluid: pelvic peritoneal reflections, right and left paracolic gutters, superior part of the sigmoid mesocolon, ileocolic area, and the right subdiaphragmatic space. The differential diagnosis is broad and covers primary peritoneal malignancies, as well as many benign disorders such as endometriosis, and inflammatory and infectious diseases. Peritoneal carcinomatosis, which is the most common malignant process of the peritoneal cavity, originates mostly from colorectal, gastric, and gynaecological malignancies.
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