Spread of Metastatic Disease in the Abdomen and Pelvis

  • James A. Brink
  • Ali Shirkhoda


Basic knowledge of the normal intra-abdominal anatomy and of the anatomical variants is essential to understanding the spread of pathology within the peritoneum. Of special importance are constant landmarks, i.e., the anatomical relationships maintained and bounded by peritoneal and fascial attachments as well as by the abdominal adipose tissue. The peritoneal and extraperitoneal spaces and their fascial planes create complex three-dimensional structures with unique radiological characteristics. Intraperitoneal and extraperitoneal adipose tissue provides contrast interfaces between the organs and visceral structures. The intra-abdominal adipose also yields clues as to the spread and localization of many pathological conditions.


Caudate Lobe Great Omentum Hepatoduodenal Ligament Transverse Mesocolon Left Hepatic Lobe 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Levy AD, Shaw JC, Sobin LH (2009) Secondary tumors and tumorlike lesions of the peritoneal cavity: imaging features with pathologic correlation. RadioGraphics 29:347–373CrossRefPubMedGoogle Scholar
  2. 2.
    Meyers MA, Oliphant M, Berne AS, Feldberg MAM (1987) The peritoneal ligaments and mesenteries: pathways of intraabdominal spread of disease. Radiology 163:593–604PubMedGoogle Scholar
  3. 3.
    Balfe DM, Mauro MA, Koehler RE et al (1984) Gastrohepatic ligament: normal and pathologic CT anatomy. Radiology 150:485–490PubMedGoogle Scholar
  4. 4.
    Dodds WJ, Foley WD, Lawson TL et al (1985) Anatomy and imaging of the lesser peritoneal sac. Am J Roentgenol 144:567–575Google Scholar
  5. 5.
    Low RN (2007) MR imaging of the peritoneal spread of malignancy. Abdom Imaging 32:267–283CrossRefPubMedGoogle Scholar
  6. 6.
    Meyers MA (1994) Dynamic radiology of the abdomen: normal and pathologic anatomy. 4th edn. Springer-Verlag, New YorkGoogle Scholar
  7. 7.
    Sivit CJ (1996) CT of mesentery-omentum peritoneum. Radiol Clin North Am 34:863–884PubMedGoogle Scholar
  8. 8.
    Auh YH, Rosen A, Rubenstein WA et al (1984) CT of the papillary process of the caudate lobe of the liver. AJR Am J Roentgenol 142:535–538PubMedGoogle Scholar
  9. 9.
    Donoso L, Martinez-Noguera A, Zidan A, Lora F (1989) Papillary process of the caudate lobe of the liver: sonographic appearance. Radiology 173:631–633PubMedGoogle Scholar
  10. 10.
    Weinstein JB, Heiken JP, Lee JKT et al (1986) High resolution CT of the porta hepatis and hepatoduodenal ligament. Radio-Graphics 6:55–74Google Scholar
  11. 11.
    Zirinsky K, Auh YH, Rubenstein WA et al (1985) The portacaval space: CT with MR correlation. Radiology 156:453–460PubMedGoogle Scholar
  12. 12.
    Ito K, Choji T, Fujita T et al (1993) Imaging of the portacaval space. AJR Am J Roentgenol 161:329–334PubMedGoogle Scholar
  13. 13.
    Vincent LM, Mauro MA, Mittelstaedt CA (1984) The lesser sac and gastrohepatic recess: sonographic appearance and differentiation of fluid collections. Radiology 150:515–519PubMedGoogle Scholar
  14. 14.
    Dodds WJ, Foley WD, Lawson TL et al (1985) Anatomy and imaging of the lesser peritoneal sac. AJR Am J Roentgenol 144:567–575PubMedGoogle Scholar
  15. 15.
    Langman J (1971) Medical Embryology. Part two: Special embryology. Chap. 13 Digestive system. WB Saunders, Philadelphia, PA, p 29Google Scholar
  16. 16.
    Cooper C, Jeffrey RB, Silverman PM et al (1986) Computed tomography of omental pathology. J Comput Assist Tomogr 10:62–66CrossRefPubMedGoogle Scholar
  17. 17.
    Rubesin SE, Levine MS, Glick SN (1986) Gastric involvement by omental cakes: radiographic findings. Gastrointest Radiol 11:223–228CrossRefPubMedGoogle Scholar
  18. 18.
    DeMeo JH, Fulcher AS, Austin RF (1995) Anatomic CT demonstration of the peritoneal spaces, ligaments, and mesenteries: normal and pathologic processes. RadioGraphics 15:755–770PubMedGoogle Scholar
  19. 19.
    Pai RK, Longacre TA (2007) Pseudomyxoma peritonei syndrome: classification of appendiceal mucinous tumours. In: Ceelen WP (ed) Peritoneal carcinomatosis: a multidisciplinary approach. Springer-Verlag, New York, pp 71–107Google Scholar
  20. 20.
    Vibhakar SD, Bellon EM (1984) The bare area of the spleen: a constant CT feature of the ascitic abdomen. AJR Am J Roentgenol 141:953–955Google Scholar
  21. 21.
    Rubenstein WA, Auh YH, Zirinsky K et al (1985) Posterior peritoneal recesses: assessment using CT. Radiology 156: 461–468PubMedGoogle Scholar
  22. 22.
    Love L, Demos TC, Posniak H (1985) CT of retrorenal fluid collections. AJR Am J Roentgenol 145:87–91PubMedGoogle Scholar
  23. 23.
    Crass JR, Maile CW, Frick MP (1985) Catheter drainage of the left posterior subphrenic space: a reliable percutaneous approach. Gastrointest Radiol 10:397–398CrossRefPubMedGoogle Scholar
  24. 24.
    Rubenstein WA, Auh TH, Whalen JP, Kazem E (1983) The perihepatic spaces: computed tomographic and ultrasound imaging. Radiology 149:231–239PubMedGoogle Scholar
  25. 25.
    Jeffrey RB, Federle MP, Goodman PC (1981) Computed tomography of the lesser peritoneal sac. Radiology 141: 117–122PubMedGoogle Scholar

Copyright information

© Springer Verlag Italia 2010

Authors and Affiliations

  • James A. Brink
    • 1
  • Ali Shirkhoda
    • 2
  1. 1.Department of Diagnostic RadiologyYale University School of MedicineNew HavenUSA
  2. 2.Diagnostic RadiologyWilliam Beaumont HospitalRoyal OakUSA

Personalised recommendations