Omental cake

Sonography may be used in patients with intestinal tuberculosis to document its classic features, i.e., bowel wall thickening, hyperemia, stricture, and mesenteric lymphadenopathy. When tuberculous peritonitis coexists, sonography shows ascites, omental cake, and thickened mesentery with an adherent small bowel loop thus, ultrasonography maybe used as a primary investigative tool in patients with suspected or recurrent tuberculosis. 

Fig. 18.6a,b. The omental cake sign neoplastic infiltration of the great omentum is visualized by ultrasound as uniformly thick, hyposonic band-shaped structure adjacent to the anterior and lateral walls of the abdomen, following the contour of the abdominal convexity and containing low-level non-structural internal echoes... 

The omentum accounts for the most common sites of peritoneal metastases, with the inframesocolic omentum more often involved than the supramesocolic omentum. Most common types of omental implants include a net-like pattern,nodules of various sizes, and broad, bandlike soft-tissue lesions, an omental cake (Fig. 10.8). Nodular enhancing implants and omental cake are typically located between the abdominal wall and bowel loops. 

Fig. 10.8a-d. Omental implants. Transaxial CT (a-c) and transaxial fat-saturated Tl-weighted image (d) in four different patients. Omental implants (arrows) may display a broad spectrum of findings ranging from a netlike pattern (a) to cottonlike (b) and nodular lesions (d). They are typically located between the abdominal wall and bowel loops. If they coalesce they are termed omental cake (c)... 

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