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A 77-year-old man presented with a two-month history of increasing abdominal girth,
weight loss and early satiety. Physical examination revealed a distended, nontender
abdomen with dullness on percussion. The complete blood count and the liver function
tests were normal whereas serologic tests for viral hepatitis were negative. A computed
tomography (CT) scan of the abdomen showed a large amount of ascitic fluid resulting
in central displacement of the small bowel and mesentery without septa of calcifications.
A blind paracentesis in the left lower quadrant of the abdomen revealed a green gelatinous
jelly which was impossible to aspirate. The ultrasonography (US) of the abdomen (Fig. 1) showed multiple septations in the peritoneal cavity surrounded by ascites with a
“starburst” appearance and with echogenic foci within. The omentum appeared irregularly
thickened. The bowel loops were displaced centrally and were non mobile instead of
floating freely.
Fig. 1Ultrasonography of the abdomen of a 77-year-old man with pseudomyxoma peritonei Panel
A: ascitic fluid with multiple septations (arrows) and irregularly thickened omentum
(asterisk) Panel B: “starburst” appearance of the ascitic fluid due to echogenic foci
reflecting the gelatinous nature of the fluid.
