Diaphragmatic peritoneal metastases mimicking liver metastases

Barbara Noiret; Clarisse Eveno

doi:10.1515/pp-2021-0120

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Diaphragmatic peritoneal metastases mimicking liver metastases

Barbara Noiret and Clarisse Eveno

Published/Copyright: August 20, 2021

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From the journal Pleura and Peritoneum Volume 6 Issue 3

Keywords: cytoreductive surgery; diaphragmatic peritoneal metastases; hyperthermic intraperitoneal chemotherapy (HIPEC); liver metastases; scalloping

A 27-year-old male presented with abdominal pain and asthenia. Abdominal CT-scan identified left colon mass associated with synchronous peritoneal metastases (PM) and hypodense liver suspicious lesions (Figure 1A, arrow). Colonoscopy with pathological analysis of colic biopsies confirmed an adenocarcinoma with microsatellite instability, allowing to perform neoadjuvant immunotherapy (Pembrolizumab). Explorative laparotomy confirmed the PM with the presence of implants on the right diaphragmatic dome (Figure 1B, arrow) exerting extrinsic compression of the liver (Figure 1B, star). A complete cytoreductive surgery combined with Mitomycin C based-hyperthermic intraperitoneal chemotherapy (HIPEC) was performed.

Figure 1:

CT-scan (A) revealed hypodense liver lesions (arrow) at the diagnosis of left colon adenocarcinoma with synchronous peritoneal metastases. Explorative laparotomy (B) highlighted diaphragmatic peritoneal metastases (arrow) exerting pressure on the liver surface, called «scalloping» (star).

PM are often located in Douglas pouch, parieto-colic gutters, and also in the subphrenic space. Therefore, peritoneal tumor implants under the diaphragm can mimic liver metastases on CT-scan [1, 2] by exerting pressure on the liver surface, called “scalloping” [3]. It is essential to distinguish diaphragmatic PM and liver metastases and to carry out further investigations in case of doubt, because of their different therapeutic strategies.

Corresponding author: Barbara Noiret, Claude Huriez Hospital, Rue Michel Polonowski, Lille 59037 France, E-mail: barbara_noiret@orange.fr

Research funding: None declared.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Informed consent: Informed consent was obtained from all individuals included in this study.
Ethical approval: Not applicable.

References

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2. Harimoto, N, Shimada, M, Shirabe, K, Tanaka, S, Taketomi, A, Tsujita, E, et al.. Images of interest. Hepatobiliary and pancreatic: peritoneal dissemination mimicking liver metastases. J Gastroenterol Hepatol 2004;19:938. https://doi.org/10.1111/j.1440-1746.2004.03569.x.Search in Google Scholar PubMed

3. Allart, K, Sabbagh, C, Regimbeau, J-M. Liver scalloping: pseudomyxoma peritonei liver compression. J Vis Surg 2019;156:75–6. https://doi.org/10.1016/j.jviscsurg.2018.09.001.Search in Google Scholar PubMed

Received: 2021-03-15

Accepted: 2021-07-20

Published Online: 2021-08-20

This work is licensed under the Creative Commons Attribution 4.0 International License.

Articles in the same Issue

https://doi.org/10.1515/pp-2021-0120

Keywords for this article

cytoreductive surgery; diaphragmatic peritoneal metastases; hyperthermic intraperitoneal chemotherapy (HIPEC); liver metastases; scalloping

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