Neoplastic and Nonneoplastic Conditions of Serosal Membrane Origin: CT Findings
Abstract
Computed tomography (CT) is an important imaging modality for diagnosis and follow-up of neoplastic or nonneoplastic conditions of the serosal membrane. The characteristic CT findings of malignant pleural mesothelioma include unilateral pleural effusion, thickening of the mediastinal pleura, and circumferential and nodular pleural thickening of greater than 1 cm. Malignant peritoneal mesothelioma manifests as a large mass or diffuse peritoneal thickening without a definable mass and is difficult to differentiate from peritoneal carcinomatosis or tuberculosis. The imaging features of primary serous papillary carcinoma of the peritoneum resemble those of peritoneal carcinomatosis; however, the ovary is usually of normal size. The possibility of desmoplastic small round cell tumor should be considered in children or young adults with multiple peritoneal masses and no identifiable primary malignancy. The CT findings of secondary tumors include a variable amount of fluid in the serosal cavity, thickening of the serosal lining (irregular and nodular), and serosal implants. Nonneoplastic conditions manifest as focal or diffuse thickening of the serosal membrane, a variable amount of fluid in the serosal cavity, and a soft-tissue mass at CT. Although the CT findings of some of the conditions overlap, knowledge of the typical findings is helpful in narrowing the differential diagnosis.
© RSNA, 2008
References
- 1
, Habbal OA, Moqattash ST. The role of the diaphragm in lymphatic absorption from the peritoneal cavity. J Anat1995; 186(pt 3): 453–467.Abu-Hijleh MF - 2
, McCaughey WTE. Development, anatomy, and function of the serosal membranes. In: Rosai J, ed. Tumors of the serosal membranes. Washington, DC: Armed Forces Institute of Pathology, 1995; 1–7.Battifora H - 3
, Muller NL, Miller RR. CT in differential diagnosis of diffuse pleural disease. AJR Am J Roentgenol1990; 154: 487–492.Leung AN - 4
, Bhalla S. Unusual nonneoplastic peritoneal and subperitoneal conditions: CT findings. RadioGraphics2005; 25: 719–730.Pickhardt PJ - 5
, Bhalla S. Primary neoplasms of peritoneal and subperitoneal origin: CT findings. RadioGraphics2005; 25: 983–995.Pickhardt PJ - 6
, Horton KM, Garland MR, Fishman EK. Mesenteric neoplasms: CT appearances of primary and secondary tumors and differential diagnosis. RadioGraphics2003; 23: 457–473.Sheth S - 7
. The coelomic cavities and mesenteries. In: Moore KL, ed. The developing human: clinically oriented embryology. 3rd ed. Philadelphia, Pa: Saunders, 1982; 303–317.Moore KL - 8
, Dalley AF. Thorax. In: Moore KL, ed. Clinically oriented anatomy. 4th ed. Baltimore, Md: Lippincott Williams & Wilkins, 1999; 61–155.Moore KL - 9
, Staveteig PT, Narra VR, Leyendecker JR, Lewis JS Jr, Brown JJ. MRI of the peritoneum: spectrum of abnormalities. AJR Am J Roentgenol2006; 186: 1368–1379.Elsayes KM - 10
, Reznek RH. The peritoneum, mesenteries and omenta: normal anatomy and pathological processes. Eur Radiol1998; 8: 886–900.Healy JC - 11
. Clinical embryology of the abdomen: normal and pathologic anatomy. In: Meyers MA, ed. Dynamic radiology of the abdomen: normal and pathologic anatomy. 5th ed. New York, NY: Springer-Verlag, 2000; 9–56.Meyers MA - 12
, Lake RA. Advances in malignant mesothelioma. N Engl J Med2005; 353: 1591–1603.Robinson BW - 13
, Unni KK, Muhm JR, Jett JR, Ilstrup DM, Bernatz PE. Diffuse malignant mesothelioma of pleura: diagnosis and survival in 92 cases. Cancer1986; 58: 1540–1551.Adams VI - 14
. Asbestos and the lung. Chest1989; 95: 1304–1308.Dunn MM - 15
, Libshitz HI. Malignant pleural mesothelioma: CT manifestations in 50 cases. AJR Am J Roentgenol1990; 155: 965–969.Kawashima A - 16
, Reddy GP, Gotway MB, et al. Malignant pleural mesothelioma: evaluation with CT, MR imaging, and PET. RadioGraphics2004; 24: 105–119.Wang ZJ - 17
, Rusthoven J. Malignant pleural mesothelioma: update, current management, and newer therapeutic strategies. Chest2004; 126: 1318–1329.Pistolesi M - 18
, Pogrebniak HW. Malignant pleural mesothelioma. Curr Probl Surg1993; 30: 921–1012.Pass HI - 19
, Sordillo PP, Magill GB, Golbey RB. Malignant mesothelioma of the pleura: review of 123 patients. Cancer1982; 49: 2431–2435.Brenner J - 20
, Smith K. Extrathoracic lymph node metastases in malignant pleural mesothelioma. Chest1988; 93: 443–444.Huncharek M - 21
. Peritoneum, mesentery, and extraperitoneal soft tissues. In: Skucas J, ed. Advanced imaging of the abdomen. London, England: Springer-Verlag, 2005; 865–932.Skucas J - 22
, Reznek RH, Selleslag D, Geraghty R, Slevin M. Peritoneal mesothelioma: the role of computed tomography in diagnosis and follow up. Clin Radiol1992; 45: 79–84.Guest PJ - 23
, Vardareli E, Adapinar B, Acikalin M. CT findings and serum CA 125 levels in malignant peritoneal mesothelioma: report of 11 new cases and review of the literature. Eur Radiol2003; 13: 2620–2626.Kebapci M - 24
, Chen S, Proietto T. Peritoneal mesothelioma: CT and MRI findings. Australas Radiol2002; 46: 91–96.Puvaneswary M - 25
, McCaughey WTE. Development, anatomy, and function of the serosal membranes. In: Rosai J, ed. Tumors of the serosal membranes. 3rd ed. Washington, DC: Armed Forces Institute of Pathology, 1995; 89–100.Battifora H - 26
, Bree RL, Francis IR, Korobkin M. CT appearance of primary papillary serous carcinoma of the peritoneum. AJR Am J Roentgenol1998; 171: 687–689.Stafford-Johnson DB - 27
, Ueda J, Takahashi S, et al. Peritoneal serous papillary carcinoma: radiological appearance. Abdom Imaging1999; 24: 78–81.Furukawa T - 28
, Laurie LR, Chintapalli KN, Valente PT, Dodd GD 3rd. Primary papillary serous carcinoma of the peritoneum: CT-pathologic correlation. J Comput Assist Tomogr2000; 24: 395–399.Chopra S - 29
, Kim JK, Cho KS. CT features of serous surface papillary carcinoma of the ovary. AJR Am J Roentgenol2004; 183: 1721–1724.Kim HJ - 30
, Proietto T. Primary papillary serous carcinoma of the peritoneum: four cases and review of computed tomography findings. Australas Radiol2004; 48: 421–425.Puvaneswary M - 31
, Eble JN, King D, Bethwaite PB, Nacey JN, Thornton A. Immunohistochemical evidence for mesothelial origin of paratesticular adenomatoid tumour. Histopathology2000; 36: 109–115.Delahunt B - 32
, Gottlieb RH, Oka M, Rubens DJ. Sonography of the scrotum. Radiology2003; 227: 18–36.Dogra VS - 33
, Tavassoli FA. Multicystic mesothelioma: an analysis of pathologic findings and biologic behavior in 37 cases. Am J Surg Pathol1988; 12: 737–746.Weiss SW - 34
, Kim-Ahn G, O’Bryant LK. Multicystic mesothelioma of the peritoneum. AJR Am J Roentgenol2002; 178: 402.Bui-Mansfield LT - 35
, Ros PR, Storm BL, Buck JL, Wilkinson EJ. Cystic mesothelioma of the peritoneum. Radiology1989; 170: 333–337.O’Neil JD - 36
, Miller HK, Battifora H, Miettinen M, Silva EG, Rosai J. Intra-abdominal desmoplastic small round-cell tumor: report of 19 cases of a distinctive type of high-grade polyphenotypic malignancy affecting young individuals. Am J Surg Pathol1991; 15: 499–513.Gerald WL - 37
, Suzuki-Bordalo L, Brecher E, Ginsberg JP, Maris J, Pawel BR. Desmoplastic small round cell tumor in the abdomen and pelvis: report of CT findings in 11 affected children and young adults. AJR Am J Roentgenol2005; 184: 1910–1914.Bellah R - 38
, Fisher AJ, Balfe DM, Dehner LP, Huettner PC. Desmoplastic small round cell tumor of the abdomen: radiologic-histopathologic correlation. Radiology1999; 210: 633–638.Pickhardt PJ - 39
, Zolliker AS, McCaughey WT, Jacques J, Kannerstein M. Localized primary tumors of the pleura: an analysis of 40 cases. Cancer1979; 44: 1465–1475.Dalton WT - 40
, Im JG, Choe KO, Kim CJ, Lee BH. CT findings in benign fibrous mesothelioma of the pleura: pathologic correlation in nine patients. AJR Am J Roentgenol1992; 158: 983–986.Lee KS - 41
, Mark EJ, Dickersin GR. Solitary fibrous tumors of the pleura: eight new cases and review of 360 cases in the literature. Cancer1981; 47: 2678–2689.Briselli M - 42
, Meary E, Buy JN, Pigeau I, Kirschner PA. Localized fibrous pleural mesothelioma: CT findings. Clin Imaging1991; 15: 105– 108.Mendelson DS - 43
, McLoud TC, Shepard JA, Shipley RT. Computed tomography of localized pleural mesothelioma. AJR Am J Roentgenol1985; 144: 275–280.Dedrick CG - 44
, Jung JI, Lee MS, et al. CT differentiation of tuberculous peritonitis and peritoneal carcinomatosis. AJR Am J Roentgenol1996; 167: 743–748.Ha HK - 45
, Carr DT. Pleural effusion: a statistical study of 436 patients. N Engl J Med1955; 252: 79–83.Leuallen EC - 46
, Scott WW Jr, Baker RR, Wharam MD, Siegelman SS. Invasive thymomas: diagnosis and evaluation by computed tomography. J Comput Assist Tomogr1982; 6: 92–100.Zerhouni EA - 47
, Eng P. Pleural changes in malignant pleural effusions: appearance on computed tomography. Cleve Clin J Med1994; 61: 127–131.O’Donovan PB - 48
, O’Neill H, Amin AI, Moran B. CT in pseudomyxoma peritonei: a review of 17 cases. Clin Radiol2002; 57: 608–613.Sulkin TV - 49
, Edge JR. The early radiological changes in pulmonary and pleural asbestosis. Clin Radiol1970; 21: 355–365.Fletcher DE - 50
, Kagan E, Schwartz A, Kriebel D, Hix W, Rohatgi P. Visceral pleural thickening in asbestos exposure: the occurrence and implications of thickened interlobar fissures. J Thorac Imaging1987; 2: 58–66.Rockoff SD - 51
, Davies GJ, Attanoos R, Crane M, Adams H, Phillips S. Asbestos: when the dust settles—an imaging review of asbestos-related disease. RadioGraphics2002; 22(spec issue): S167–S184.Roach HD - 52
, Fiel SB, Fisher MS, Radecki PD, Lev-Toaff AS, Caroline DF. Asbestos-related pleural disease and asbestosis: a comparison of CT and chest radiography. AJR Am J Roentgenol1988; 150: 269–275.Friedman AC - 53
, Honma K, Saito Y, et al. Pleural disease in silicosis: pleural thickening, effusion, and invagination. Radiology2005; 236: 685–693.Arakawa H - 54
. The clinical relevance of asbestos-induced pleural fibrosis. Ann N Y Acad Sci1991; 643: 169–177.Schwartz DA - 55
, Gasser B, Gangi A, et al. Imaging of cystic masses of the mediastinum. RadioGraphics2002; 22(spec issue): S79–S93.Jeung MY - 56
, Sumkin JH. Sclerosing peritonitis associated with luteinized thecomas. AJR Am J Roentgenol1996; 167: 512–513.Reginella RF - 57
, Shirahatti RG, Anand J. CT findings of an abdominal cocoon. AJR Am J Roentgenol2004; 183: 1658–1660.Gupta S - 58
, Lawler LP, Fishman EK. CT findings in sclerosing mesenteritis (panniculitis): spectrum of disease. RadioGraphics2003; 23: 1561–1567.Horton KM - 59
, Jeffrey RB Jr, Lane MJ, Silverman PM. The misty mesentery on CT: differential diagnosis. AJR Am J Roentgenol1996; 167: 61–65.Mindelzun RE - 60
, Lee HJ, Woo SK, Lee TS. Peritoneal inclusion cysts and their relationship to the ovaries: evaluation with sonography. Radiology1997; 204: 481–484.Kim JS - 61
. Imaging of peritoneal inclusion cysts. AJR Am J Roentgenol2000; 174: 1559–1563.Jain KA