Earlier this week, we discussed the case of a young woman who immigrated from Mexico as a child, who presented with subacute fever, increased abdominal girth and acute onset abdominal pain, nausea, and PO intolerance found to have ascites with SAAG <1.1 consistent with exudative ascites, and diffuse peritonitis on CT.

We reviewed the differential for exudative ascites as the following:
Peritoneal Carcinomatosis
Peritoneal Tuberculosis
Pancreatitis
(additionally serositis, nephrotic syndrome, bowel perforation/infarction)

We reviewed the diagnostic studies for peritoneal TB and notably learned that elevated ascites fluid adenosine deaminase level is particularly helpful in supporting in a diagnosis of peritoneal TB and against diagnosis of peritoneal carcinomatosis.

We reviewed the utility of different imaging modalities when suspecting gynecologic malignancy, notably Ultrasound being first line imaging modality, MRI having the role of detecting pelvic extent of disease and local staging, and finally CT and PET/CT to evaluate extra-pelvic disease and distant metastases.