Differential Diagnosis for Moderate Ascites with Omental Caking

• Single Most Likely Diagnosis
  • Ovarian Cancer: Omental caking is a classic sign of ovarian cancer, particularly in the context of moderate ascites. The omentum's involvement suggests metastatic disease, which is common in advanced ovarian cancer.
• Other Likely Diagnoses
  • Gastrointestinal Cancer (e.g., gastric, colon): Cancers of the gastrointestinal tract can metastasize to the omentum, leading to omental caking, and can also cause ascites due to peritoneal carcinomatosis.
  • Peritoneal Carcinomatosis from Other Primary Sites: Other cancers, such as breast, lung, or pancreatic cancer, can also metastasize to the peritoneum, causing ascites and omental involvement.
• Do Not Miss Diagnoses
  • Tuberculous Peritonitis: Although less common, tuberculous peritonitis can cause ascites and peritoneal thickening, which might be mistaken for omental caking. It's crucial to consider this diagnosis, especially in endemic areas or in patients with risk factors for tuberculosis.
  • Lymphoma: Certain types of lymphoma can involve the peritoneum and cause ascites. Missing this diagnosis could lead to delayed appropriate treatment.
• Rare Diagnoses
  • Pseudomyxoma Peritonei: A rare condition characterized by recurrent mucinous ascites, often due to a primary mucinous tumor of the appendix. It can cause omental caking due to the deposition of mucin.
  • Primary Peritoneal Cancer: A rare malignancy that arises from the peritoneal lining itself, which can present with ascites and omental caking similar to ovarian cancer.