0:01

Pseudomyxoma on CT does have a different

0:03

appearance than it does on the brain.

0:05

Regular ascites on CT, but it also has

0:07

a different appearance on ultrasound.

0:09

So this is the same patient who came in for a

0:11

paracentesis, knowing that it was a ruptured

0:14

mucosal and that it was going to contain more

0:17

dense kind of material here that a paracentesis

0:20

might not work, but they were out of options and

0:22

the patient was extraordinarily uncomfortable

0:25

given how much fluid they had in their belly.

0:28

So here's a picture from

0:29

an ultrasound right here.

0:30

You can see your bowel loops kind of

0:32

floating in this material right here.

0:34

And again, you can just see this

0:35

isn't anechoic, simple free fluid.

0:37

It is insinuating in between these bowel

0:40

loops, but it has more echogenicity to it,

0:42

all these echogenic kind of foci in it.

0:45

So you go through here, this

0:46

is absolutely legitimate.

0:48

This isn't just artifact.

0:49

This is really, you know, some hyperdense

0:51

material within the cystic space.

0:53

Right here.

0:54

And because of that, you would warn the

0:55

patient that when you do this paracentesis,

0:57

you may not get a lot of fluid out.

0:59

This may be too thick to come out your

1:00

paracentesis catheter, but that given

1:03

discomfort, it may be worthwhile.

1:05

The other things that you can look for

1:07

on these is this will actually move

1:09

when you put an ultrasound probe, but

1:11

if you push their belly a little bit.

1:12

So here's an image from the paracentesis

1:16

itself, you can see the needle coming in, but

1:18

importantly too, you can see this material

1:21

kind of move around as well.

1:23

This isn't artifact, this is actually

1:24

the mucin and that thick, thick kind

1:26

of fluid that's in there as well.

1:29

So you can try paracentesis with these.

1:31

This one actually was fairly successful, got

1:33

a couple liters out and helped the patient,

1:35

but they may not always be successful

1:37

and you have to counsel the patient that.