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Mucocele Perforation

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0:01

So this is the same patient that presented

0:03

to our institution a few months later,

0:05

in regards to their presumed mucocele.

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Remember too that mucoceles can range from

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the benign mucinous cystadenoma to malignant

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variety, which is the cystadenocarcinoma, with

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any kind of level in between, including LAM,

0:19

which is a low-grade appendiceal mucinous tumor.

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So same patient, you'll recognize this

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mucocele, you'll see that calcification in the

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center of it, some in the walls right here.

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But something happened in the interim.

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So we scroll through it.

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It looks pretty much similarly dilated.

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There's not really any inflammation around it.

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We don't have an acute appendicitis

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component of this, but you do now have

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this almost loculated fluid anterior to it.

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And if you're looking closely at the

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wall, we've lost the wall right here.

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So in between those several months of when that

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patient presented to the outside institution

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and then came to our institution for surgery

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and for purposes of planning their surgery.

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Okay.

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This mucous cyst ruptured.

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You have loss of integrity

1:00

of the wall right here.

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You can also tell this isn't an abscess.

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This is the mucous cyst

1:04

itself by handful of units.

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It's virtually identical.

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If you put them on, there's no enhancing wall.

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However, this does look loculated.

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It's not like free fluid that

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should flow into the pelvis.

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You can see here, there really is no

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free fluid layering in the pelvis.

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And that's because this isn't free fluid.

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This is mucus.

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So it's going to kind of sit where it

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ruptured from, but it's not an abscess.

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There's no thick wall.

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There's nothing enhancing right here.

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So it's kind of this in

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between sort of appearance.

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In this case, the mucous cyst ruptured,

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which is very important for the surgeon to

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know, because it goes from a simple, uh,

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Appendectomy, partial colectomy, take this out.

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This hasn't spread anywhere, so this

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is clearly spread into the peritoneum.

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And now you might have to consider further

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therapies such as beyond just cytoreductive

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therapy, where you get out all the deposits

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that you can, but you might need HIPEC, which

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is hypothermic intraperitoneal chemotherapy.

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This is still a little bit

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tricky and controversial.

2:00

This therapy itself, but at our

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institution, it's pretty, pretty standard

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for what we'll do in cases like this.

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So this person did end up going to get their

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mucosal taken out and it had ruptured as

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you know, it was very clear on the CT scan

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itself and they did end up getting HIPEC

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and this ended up being a low-grade

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appendiceal mucinous neoplasm, but as you

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can tell, given that this is here, this

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kind of gelatinous mucinous material, it's

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going to be much trickier, longer surgery,

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with possible recurrence simply because you

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cannot clear out all of that very easily

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in a surgery, whereas you can just take

2:33

the appendix out if it hasn't ruptured yet.

Report

Faculty

Kathryn McGillen, MD

Assistant Professor of Radiology, Medical Director of Ultrasound

Penn State University Milton S Hershey Medical Center

Tags

Neoplastic

Gastrointestinal (GI)

CT

Body

Appendix

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