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Clinical presentation
A previously well 69-year-old British man presented with a 4-week history of anorexia, weight loss, drenching night sweats, marked lethargy and abdominal pain. Examination revealed pleural effusions and gross ascites. There was no jaundice, fever, cough, signs of chronic liver disease or palpable lymphadenopathy. Investigations revealed a haemoglobin 12.9 g/dl, white cell count 11.3x10 9 /litre, neutrophils 10.4x109 /litre, platelets 704x109 /litre; creatinine of 107 μmol/l; normal liver enzymes; corrected calcium of 2.23 mmol/l; lactate dehydrogenase 4640 U/l (normal 125-243 U/l); urate 1201 μmol/l (normal <450 μmol/l) and negative HIV serology. CT chest and abdomen ( figures 1 and 2 ) were performed. The patient's poor condition precluded formal tissue biopsy so an ascitic tap was performed and cytology examined ( figure 3 ).
Question
What is the diagnosis?
See page 860 for the answer
Answer
From the question on page 852
A contrast enhanced CT examination demonstrated a large right-sided pleural effusion with compressive atelectasis of the underlying right lower lobe. Large volume ascites was confirmed with evidence of extensive omental infiltration or 'caking'. Abnormal omental tissue anterior to the ascending colon had a maximal thickness of 5 cm (see figure 1 in the question). An ill-defined 1.9-cm aorto-caval lymph node was also noted (see figure 2 in the question). The CT features were reported as typical of disseminated intraperitoneal malignancy, most likely...