Omental Cake

This 56 year-old male presented with abdominal pain on a background of known gastric carcinoma. The axial CT image shows heterogeneous fat / soft-tissue density within the greater omentum (click image for arrows). There is also moderate ascites. The appearance is typical of omental cake. The patient also had extensive liver metastases.
Omental cake refers to infiltration of the omental fat by material of soft-tissue density. The most common causes are metastases from ovary, stomach or colon. Tuberculous peritonitis may also give this appearance. Masses on the peritoneal surfaces may also be present. Malignant ascites may be present.
Core biopsy may be helpful if the primary tumour is unknown.
References:
1. Weissleder R, Wittenberg J, Harisinghani MG. Primer of Diagnostic Imaging 3rd edition. Mosby 2003
2. Roche C, et al. Selections from the Buffet of Food Signs in Radiology. Radiographics 2002; 22: 1369-1384.
Credit: Dr Laughlin Dawes
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