Mucinous ascites

A 77-year-old female with a 2-month history of ascites, a right hepatic flexure mass, and peritoneal carcinomatosis presented with worsening abdominal distension, weakness and encephalopathy. Bedside ultrasound showed dense loculated ascites and hyperechoic fluid (Video 1). Abdominal computed tomography (CT) images were reviewed to ensure ultrasound findings were not cystic renal masses or dilated bowel loops (Figure 1). During the paracentesis, thick, gelatinous ascitic fluid repeatedly clogged the 8 F catheter, resulting in procedure termination after aspiration of 150 mL of fluid (Video 2). Mucinous ascites most often results from low- or high-grade mucinous appendiceal tumors and much less often from other sites such as ovarian teratomas, colorectal tumors, urachus, and pancreatic tumors.1 The term pseudomyxoma peritonei (PMP) is used when mucinous deposition follows the phenomena of “redistribution,” with selective deposition in specific sites in the greater omentum, liver capsule, and pericolic gutters.1 Mucinous deposits along serosal surfaces can result in “scalloping” of the liver or spleen on CT and ultrasound.2 The appearance of the ascitic fluid on ultrasound is often echogenic and septated.2 Ascitic fluid may not provide additional diagnostic information, aside from fluid characteristics, as large quantities of acellular mucin may limit cytologic evaluation. Diagnosis and staging require peritoneal biopsy for histologic grading and identifying the primary tumor site.1, 2 Large volume paracentesis for palliation of mucinous ascites can be difficult due to fluid viscosity and laparoscopic surgical drainage may provide palliative relief in cases such as ours. The authors have no funding to report. The authors declare no conflict of interest. Informed consent for this case presentation was obtained from the patient's designated medical decision maker. The authors have nothing to report.