Yesterday we discussed poor peritoneal detail as an increase in soft tissue opacity and loss of the fat-soft tissue interfaces that show the serosal surfaces of organs. There is another pattern of poor peritoneal detail, that looks like a mottled or streaky increase in soft tissue opacity within the fat. This presentation has unique causes, and alternate differential diagnoses. The two differential diagnoses that I use for the mottled abdomen are a small amount of peritoneal effusion, and carcinomatosis. Generally the abdominal contour is normal with mottled peritoneal detail. That’s because a small amount of fluid will just dissect between some of the fat folds and planes in the mesentery, and is not enough to distend it. Carcinomatosis can produce enough fluid to distend the abdomen, but then it just looks like peritoneal effusion. In its earlier form, it seems to make the omentum and falciform fat edematous, with a small amount of free fluid. This results in streaks or stripes of soft tissue opacity in the normally homogeneous peritoneal space. Here’s my summary:
Poor peritoneal detail differential diagnoses:
- Young animal
- lack of fat, small amount of normal fluid
- Uniform soft tissue opacity, distended abdomen
- Peritoneal effusion (hemoabdomen, uroabdomen, transudate, peritonitis, carcinomatosis)
- Focal poor peritoneal detail
- Mass
- Inflammation (pancreatitis, devitalized bowel)
- Mottled peritoneal detail, no or mild distension
- Small amount of effusion
- Carcinomatosis
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