CT Differentiation of Diffuse Malignant Peritoneal Mesothelioma, Tuberculous Peritonitis, and Peritoneal Carcinomatosis

Objective: To investigate the significance of computed tomography findings in diffuse malignant peritoneal mesothelioma (DMPeM), tuberculous peritonitis (TBP), and peritoneal carcinomatosis (PC) to differentiate the three diseases. Methods: The clinical manifestation and computed tomography scans of 147 patients with diffuse malignant peritoneal mesothelioma (n = 60), tuberculous peritonitis (n = 32), and peritoneal carcinomatosis (n = 55) were retrospectively reviewed, while taking into account of ascites, pleural plaques, viscera infiltration; abnormalities in the peritoneum; involvement of the mesentery and omentum; as well as the presence and location of enlarged lymph nodes. Results: There was no significant difference among all three groups in terms of clinical manifestation, peritoneum, omentum, and mesentery involvement, ascites, as well as the presence and location of enlarged lymph nodes. The study found that 95% of DMPeM patients had been exposed to asbestos in the past. The patients showed significant differences in the following aspects: (1) irregular peritoneum thickening, caked omentum thickening, pleural plaques, visceral infiltration, and asbestos exposure were more common in peritoneal mesothelioma patients; (2) nodular peritoneum thickening and visceral metastasis were more common in patients with peritoneal carcinomatosis; (3) smooth peritoneal thickening, pleural effusion, and extraperitoneal tuberculosis were more common in patients with tuberculous peritonitis. Conclusion: A combination of computed tomography findings could improve our ability in differentiating the three diseases.