Ultrasonography has been used successfully for detecting omental cysts and lipomas in the pediatric age group ( 1 , 2 ) . The case reported here demonstrates sonographic visualization of a n omental mesothelioma in a n adult.
CASE REPORT
J.R., a 32-year-old white male, presented with 6 weeks of increasing abdominal girth, decreased appetite, a 10-pound weight loss, and diffuse abdominal pain. Complete blood count, upper gastrointestinal series, and barium enema on a n outpatient basis were normal. There was no history of alcoholism, exposure to hepatic toxin, previous cardiac or renal disease, nausea, vomiting, or jaundice. Physical examination revealed a distended, tympanic abdomen, but no evidence of shifting dullness, spider angioma, pedal edema, or venous distension. The liver was believed on the basis of palpation to be enlarged below the costal margin. Chest x-ray and laboratory studies were normal. Abdominal x-ray revealed the presence of ascites. Paracentesis revealed a bloody exudate with elevated protein, LDH, and SGPT. Cytology was negative for malignant cells. A technetium-labeled sulfur colloid scan showed diffuse hepatomegaly without colloid shift. Clinical considerations a t this point included Budd-Chiari syndrome, lymphoma, and Hodgkin's disease. U1trasonographic examination revealed the presence of ascites and an irregular lobulated solid mass ( 5 x 10 x 14 cm) adherent to the lower anterior abdominal wall (Figs. ). Hepatic arteriovenous angiography was normal. Superior mesenteric artery injection was also normal. Celiac injection filled a large right gastroepiploic artery. Multiple large omental branches showed neovascularity and tumor blush. Arteriographic From the Division of Ultrasound. Department of Radiology.