0:01

So the next potential evolution of

0:02

a mucocele, particularly if it's

0:04

malignant, is the pseudomyxoma peritonei.

0:08

And in that case, what you'll see is

0:11

free fluid, or what looks somewhat like

0:14

free fluid everywhere on the CT scan.

0:16

In this particular patient, she

0:17

had had an appendectomy for a

0:20

mucocele that was malignant.

0:22

You can see her surgical clips where

0:23

you'd expect to see the appendix.

0:25

However, in that case, it had ruptured

0:28

at that point as well and resulted

0:31

eventually in a pseudomyxoma peritonei.

0:33

And the way that you can tell this

0:34

is different than just regular

0:35

free fluid is it has mass effects.

0:37

So it does insinuate in between structures

0:40

like free fluid, with a mass effect.

0:43

And you can see the scalloping

0:44

edge of the liver right here.

0:45

You can often see it on the

0:46

stomach or the spleen as well.

0:48

Just this mass effect that you see right here,

0:51

and you can have soft tissue deposits in it.

0:53

If you put Hounsfield units on it,

0:54

it may look like simple free fluid.

0:56

It may also be a little bit brighter.

0:58

And that's again, because

1:00

it has not just free fluid.

1:02

It has this mucin.

1:04

And it has a little bit more mass effect to it.

1:07

In these particular cases, I love

1:08

to look at the coronal images.

1:10

It's good for looking for peritoneal

1:11

deposits, particularly if they are

1:13

depositing along the diaphragm.

1:14

I find it's much easier to

1:15

see on the coronal image.

1:16

This also really nicely

1:18

shows you that scalloping.

1:19

You can see the margins of the liver are

1:21

definitely scalloped and kind of lobulated here.

1:24

You can see the mass effect

1:26

upon the stomach itself.

1:30

And again, just insinuating,

1:32

but not quite draping.

1:33

You can almost see the fat planes

1:35

still that are still present because

1:37

this isn't exactly free fluid.

1:39

It's floating freely throughout the abdomen and

1:41

the pelvis, but again it's containing mucin,

1:43

it's not free fluid, so it's going to act a

1:45

little bit differently and look a little bit

1:47

different than just plain old ascites would.