Table of Contents
Definition of Omental Caking
Thickening of the omentum resulting from localized or diffuse infiltration of omental fat by soft tissue density mass is referred as “omental caking”.
It is a radiological sign, which is often identified in CT scan.
Involved Anatomical Structure in Omental Caking
Greater Omentum – an extension of the anterior and posterior visceral peritoneum.
Causes of Omental Caking
Metastatic involvement (Commonest)
- Ovarian carcinoma (commonest cause)
- Colonic carcinoma
- Gastric carcinoma
- Pancreatic carcinoma
- Others: Endometrial carcinoma, Bladder cancer, Renal cell carcinoma, Hepato-biliary malignancies, Melanoma, Lung cancer, Breast cancer
4 routes of spread to omentum:
- Direct extension
- Intraperitoneal seeding
- Hematogenous spread
- Lymphatic spread
Primary malignancies and benign tumors of omentum (Rare)
- Abdominal mesothelioma
- Haemangiopericytoma
- Leiomyoma
- Leiomyosarcoma
- Gastrointestinal stromal tumour (GIST)
- Lipoma
- Liposarcoma
- Neurofibroma
- Fibrosarcoma
- Small round cell tumours
Infections
- Tuberculous peritonitis
- Actinomycosis
- Coccidiodomycosis
- Non-tuberculous mycobacterial infection
- Histoplasmosis
- Omental paragonimiasis
Unusual Etiologies
- Myelofibrosis
- Sclerosing omentitis
- Amyloidosis
Further Investigation in Omental Caking
Percutaneous CT or US-guided biopsy for primary diagnosis and staging.
References
Mamlouk MD, vanSonnenberg E, Shankar S, Silverman SG. Omental cakes: unusual aetiologies and CT appearances. Insights into Imaging. 2011;2(4):399-408. doi:10.1007/s13244-011-0105-4.
