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Special Feature
December 01, 2007

Image of the Month—Quiz Case

Author Affiliations

Author Affiliation:Department of Surgery, National Taiwan University Hospital, Taipei.




Copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2007

Arch Surg. 2007;142(12):1219. doi:10.1001/archsurg.142.12.1219

A 39-year-old man with alcoholism for 20 years complained of fever, intermittent diffuse abdominal pain, and progressive abdominal distention for 2 weeks. Results of physical examination and abdominal sonography revealed ascites without jaundice. Results of acid-fast staining and polymerase chain reaction of the aspirated ascitic fluid, with numerous lymphocytes, were negative for any bacilli or Mycobacterium tuberculosis. Abdominal magnetic resonance imaging showed septate fluid-containing cavities and thickened peritoneum (Figure 1). Laparotomy revealed violin string–like fibrinous strands, white miliary nodules, and omental thickening (Figure 2).

Figure 1.
Image not available

Abdominal magnetic resonance image shows lobulated ascites and thickened peritoneum.

Figure 2.
Image not available

Laparotomy reveals violin string–like fibrinous strands, white military nodules, and omental thickening.

What Is the Diagnosis?

A. Carcinomatosis peritonei

B. Sarcoidosis

C. Tuberculous peritonitis

D. Starch peritonitis