Pseudomyxoma peritonei

Discussion:

In this case, the extensive scalloping of the liver and spleen suggest rupture of a mucinous neoplasm resulting in pseudomyxoma peritonei, rather than broadly stating there is peritoneal carcinomatosis.

A close look in the right lower quadrant reveals a few calcifications with an irregular appendix or implants, suggesting ruptured appendiceal mucinous adenocarcinoma as the cause (which also happens to be the most common cause of this condition).

Because pathologic diagnosis is ultimately required, it is appropriate to guide the ordering physician toward omental biopsy, which is very safe and can be performed under ultrasound. 

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