title: Giant mucocele of the appendix: clinical and imaging findings in 3 cases.
abstract: OBJECTIVE
  Clinical and imaging (sonographic and computed tomographic [CT]) findings in 3 cases of giant mucocele of the appendix are described.
  
  
  METHODS
  Clinical records of 3 cases of giant mucocele of the appendix were reviewed. All patients had a basal B-mode sonographic examination and a contrast-enhanced sonographic examination using a second-generation low-mechanical index contrast medium. In all cases, a dual-phase spiral CT examination was carried out.
  
  
  RESULTS
  In 2 cases, the abdominal masses were discovered in asymptomatic patients; 1 patient had vague abdominal discomfort. A pathologic diagnosis of benign cystoadenoma was found at pathologic examination in all cases, and malignant pseudomyxoma peritonei was disclosed in 1 patient 1 year later. Common sonographic findings were as follows: (1) a huge abdominal mass with a maximum diameter ranging between 20 and 25 cm; (2) a thin hyperechoic border without either solid vegetations or signs of infiltration of surrounding tissues; (3) a complex internal echo structure with anechoic lacunae interspersed between curvilinear, wavy bands of echogenic material (the so-called sonographic onion skin sign); and (4) avascularity of the masses shown on contrast-enhanced sonography with a low-mechanical index medium. At CT, a well-circumscribed cysticlike mass of low attenuation was displayed in all cases. There was lack of enhancement during a dual-phase examination in 2 cases; in the other, a small peripheral area of faint enhancement was appreciated. Only in the latter case could CT reliably assess the origin of the mass.
  
  
  CONCLUSIONS
  It is suggested that a combination of sonographic (namely the onion skin sign) and CT findings may aid in the correct preoperative diagnosis of giant mucocele of the appendix.
authors.affiliation: Unità Operativa di Ecografia ed Ecointerventistica, Presidio Ospedaliero Camilliani S. Maria Della Pietà, Casoria, Italy. giampierofrancica@tin.it
authors.forename: Giampiero
authors.initials: G
authors.lastname: Francica
authors.forename: Gaetano
authors.initials: G
authors.lastname: Lapiccirella
authors.forename: Cristiano
authors.initials: C
authors.lastname: Giardiello
authors.forename: Ferdinando
authors.initials: F
authors.lastname: Scarano
authors.forename: Giovanni
authors.initials: G
authors.lastname: Angelone
authors.forename: Fedele
authors.initials: F
authors.lastname: De Marino
authors.forename: Valerio
authors.initials: V
authors.lastname: Molese
mesh_terms: D000368:Aged; D001065:Appendix / Q000000981:diagnostic imaging*; D002429:Cecal Diseases / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D009078:Mucocele / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography