• Riyadh Adel Abdulazeez College of Medicine - Thi-Qar University
  • Zaid Khdher Ahmmad College of Medicine - Karbalah University


Abdomen, ascites, CT, spiral


Back ground and purposes: Ascites is the collection of free fluid in the peritoneal cavity , normally the peritoneal cavity contain small amount of serous fluid for lubrication (less than 100 ml), free fluid exceeding this amount ,considered ascites .Ascites  may result from variety of medical  & surgical causes , clinically detectable ascites when its amount exceeding 1500 ml ,and when it is clinically important to confirm the presence of  suspected ascites, ultrasonography (US) or computed tomography (CT) of abdomen is advisable  , and the different CT signs of ascites depend on the amount and distribution of the ascetic fluid . The Aim:  is to study the early and the late signs of ascites on abdominal CT , and to estimate the sensitivity of abdominal CT in diagnosing the cause of ascites    Patients and methods: Eighty five  patients of mean age 52.2±13.8 years had ascites ,diagnosed either clinically or by US (all of them had an US examination ),  been referred for spiral CT-scan of abdomen as a further diagnostic step to confirm &identify the possible underlying cause of ascites (patients with medical causes of ascites “heart failure, renal failure ” had been excluded ), abdominal spiral CT scan has been done using 8mm slice thickness (patient took oral diluted gastrografin 1.5-2hrs prior to the  examination ) & two sets of  CT examinations had been done ( without I.V & with I.V omnipaque “350mg/ml. Results: This study showed that CT was as sensitive as US  in detection of ascites , and the different signs of ascites on CT images depended on the amount of ascetic fluid producing either (early )or( late) signs , the late signs were more frequently seen in this study . This study also showed  that CT was more useful in identifying the underlying cause of  ascites (especially  when  related to the peritoneum , momentum or to the bowel ) and the extent of the pathology and its proper staging .The frequency of the underlying causes of ascites were as follows: 62% due to underlying neoplasm ,15.5%due to underlying liver cirrhosis , 8.6% due to underlying inflammatory conditions & 3.4 % were post traumatic , however ,there were 10.3% of cases for which the CT scan didn’t give us  an idea about the underlying cause . Conclusion: CT was as sensitive as US in detection of ascites, and more useful in identifying the underlying cause of it , but still about 10% of patients requires  further investigative steps .


-Krishna K V. Gastrointerology in: A short text book of medicine, 1stedition . New Delhi :Jaypee Brothers. 1987; 399-404.

- Jeong YY. Ascites –review. Radiographics 2000 ; 20 : 1445-1470.

- Cardenas A, R Bataller, V Arroyo. Mechanism of ascites formation. Clin Liver Dis 2000; 4 :447-465.

-Field S. . The abdomen In: Grainger R.G. , Allison D.J. . Grainger &Allison’s diagnostic radiology: A text book of medical imaging . 3ededition.USA:Churchil Livingstone 1999 : 902 .

- Harding A J, Charles V. peritonium. in: Bailey & love’s short practice of surgery, 20th. England : ELBS. 1989; 1016-1017.

-Fallon M.B. ,Mcguire B.M. ,Abrams G.A. , Arguedas M.R. .Chirrhosis of the liver and its complication In : Andreoli T.E. , Carpentar C.C.J, Griggs R.C. , Loscalzo J. . CECIL essentials of medicine . 5th edition . philadelphia ,pensalvania : W.B. Saunders company 2001 :390-391 .

-Halligan S . The small bowel and periyoneal cavity. In Sutton D, eds. Text book of radiology and imaging, 17 th ed. London: churchill livingstone, 2003; 633-634.

- Gayer G, et al .Dense ascites: CT manifestation & clinical implications. Emergency Radiology 2004; 10:162-267.

- Dahnert W . gastrointistinal tract . In: Radiology review manual ,4th ed. India: William’s & Wilkin’s. 1999: 618.

- Shi Y, Hao M, Ding Z. Study on ascites of ovarian cancer . Zhonghua Fu Chan Ke Za Zhi 2000; 35 :551-553.

- Cattau E, et al .The accuracy of physical examination in the diagnosis of suspected ascites . JAMA 1982;247: 26.

- Walkey MM, et al. CT manifestation of peritoneal carcinomatosis . American Journal of Roentgenology 1988;150: 1035-1041.

- Thoeni RF. The role of imaging in patient with ascites. American Journal of Roentgenology 1995; 165: 16-18.

- Halvorsen RA , et al. CT differentiation of pleural effusion from ascites :an evaluation of four signs using blinded analysis of 52 cases . Invest Radiology 1986; 21: 191-395.

- Sanders RC, et al. Aprospective study of CT& US in detection and staging of pelvic masses . Radiology 1993; 146: 439-442.

- Christopher R W, Bouchier A D. Diseases of the liver and biliary system. In : Davidson’s principles & practice of medicine, 16thed . London : Churchil Livingston, 2002 ; 527-529.

- Blachar A, et al. Primary biliary cirrhosis: clinical ,pathological and helical CT findings in 53 patients . Radiographics 2002; 22: 1369-1384.

- Jolles H , Coulam CM . CT of ascites: differential Diagnosis. American Journal of Roentgenology 1980; 135: 315-322.

- Epstein BM, Mann J H . CT of abdominal tuberculosis . American Journal of Roentgenology 1982; 139: 861-866.

- Ha HK, et al .CT differentiation of tuberculous peritonitis & peritoneal carcinomatosis .American Journal of Roentgenology 1996;167:743-748.