[Pelvic fascia, ligaments, and spaces in neoplastic disease in computerized tomography]

The fasciae and ligaments which are visible on CT images as extremely thin structures in normal conditions tend to appear thicker in such abnormal conditions as pelvic neoplasms and are therefore easily demonstrated on axial scans. To assess the CT patterns and the meaning of fascial thickening, the CT images of 40 patients with pelvic tumors (25 rectal, 7 uterine, 6 ovarian and 2 bladder lesions) were examined. Ten cases of peritoneal carcinomatosis with ascitis were also studied. The umbilico-prevesical fascia was demonstrated in 60% of cases, while the medial umbilical ligaments, the pelvic visceral fascia and the rectovesical and rectovaginal septa were detected in 90, 96 and 100% of cases, respectively. Fascial thickening is not a specific sign of neoplastic disease since it can be due to neoplastic infiltration or be the response to an irritative stimulus. Moreover, fascial thickening can be observed also in inflammatory conditions of the pelvis and following major traumas. Thickened fasciae and ligaments make the demonstration of paravesical, intra- and extraperitoneal spaces easier, which is useful to distinguish both etiology and site of pelvic fluid collections. All these pieces of information lead to better understanding pelvic abnormalities.