The ultrasound demonstrates multiple hypoechoic masses containing scattered stationary high-amplitude echogenic foci. The masses are complex, non-compressible and some present a honeycomb appearance. The masses appear to be compressing adjacent organs.
A few interspersed anechoic areas in the right upper quadrant / Morrisson's pouch have a ‘solid’ appearance (void of respiratory movement between the liver & the right kidney)
A small pocket of ascites fluid containing some sediment is seen in the left iliac fossa.
The gallbladder wall is noted to be thin.
A non-compressible and blind-ended tubular structure is seen in the right iliac fossa, consistent with a very dilated appendix. The patient confirmed he had no history of an appendectomy.
The ascitic tap was not performed.
CT report:
Diffuse nodular low attenuation mesenteric and peritoneal fluid throughout the abdomen causing scalloping of the liver and mass effect on the bowel. A massively fluid filled dilated appendix measuring 2.4 cm in diameter, with a possible defect in the wall of the appendix. No mural thickening of the appendix.
Pseudomyxoma peritonei:
"The term pseudomyxoma peritonei is a clinical or radiologic description rather than a pathologic diagnosis. Pseudomyxoma peritonei (or jelly belly) describes the finding of copious, thick mucinous or gelatinous material on the surfaces of the peritoneal cavity".1
“The most common cause of Pseudomyxoma peritonei is a ruptured mutinous tumor of the appendix/appendiceal mucocele”.2
Typical ultrasound findings in pseudomyxoma peritonei are:
Hypoechoic spaces within the abdomen which contain dense punctuate echoes or floccules which seldom or never move with the change of body position.
Honeycomb-like septae within the hypoechoic spaces.
Notches or scalloping of the surface of liver or spleen due to the mucinous material and/or the mucinous lesions. 3