cases of linear peritoneal calcification have been reported in literature , though they occur rarely . in encapsulating peritoneal sclerosis ( eps ) a peritoneal membrane damage develops an inflammatory cascade that results in sclerosis and eventually calcification . eps has been can be either primary or secondary , being long exposure to peritoneal dialysis solutions ,   the most common cause of the secondary form . the incidence of eps has only been studied in patients on peritoneal dialysis and is estimated to be 0.544.4% , although this number can rise considerably with the time on pd . the symptoms manifest disturbances in intestinal function such as abdominal pain , nausea , vomiting and ultimately anorexia and weight loss . among the imaging techniques available , ct is the modality of choice in the diagnosis of eps , demonstrating peritoneal thickening , calcification , bowel wall thickening , bowel tethering , dilation and fluid loculation . in august 2014 a 39-year - old female presented to the emergency department of our hospital . she referred a past history of one cesarean followed by a laparoscopic tubal ligation . in october 2013 peritoneal lavage by the peritoneal catheter was performed , but abdominal wall swelling was noticed and a leak within the laparoscopic port was suspected . a ct peritoneography ( fig . iodinated contrast was injected through the peritoneal catheter and the patient was encouraged to walk , allowing a good diffusion of contrast through the peritoneal cavity . shortly after contrast injection the patient developed intense abdominal pain and hypotension that were attributed to contrast adverse reaction the ct was obtanied 30  min after contrast injection , revealing a good diffusion of contrast , with no images of leak or abdominal collections . ten days later the patient was seen for abdominal pain and elevated inflammatory markers ( c - reactive protein  =  40 ) and the tenckhoff catheter was removed for a suspected infection . the patient chose then to start hemodialysis . on the day she visited our emergency department , she reported complaints of lumbar pain and dysuria for the previous few days . laboratory data were normal , except for : hemoglobin  =  8.9 ( normal 1216  g / dl ) , leukocytosis  =  14,700 ( 400010,000 ) , leukocyturia  >  200/field ( < 5/field ) ; c - reactive protein  =  23.5 ( < 1.0 ) , urea  =  22.4 ( 2.46.4  mmol / l ) , creatinine  =  316 ( 4692  mol / l ) , pth  =  324 ( 1687  pg / ml ) , calcium  =  2.40 ( 2.102.55  mmol / l ) and phosphorus 1.47 ( 0.411.45 3 ) revealed extensive visceral ( arrows in a ) and parietal peritoneal calcification ( arrowheads in a ) with areas of focal thickening in the pelvic peritoneum ( arrowheads in c ) . she improved clinically , inflammatory markers decreased and she was then discharged from the hospital with no symptoms . cases of linear peritoneal calcification have been reported in patients on long - standing peritoneal dialysis and have previously been classified as  calcifying peritonitis  , . this term is not currently used but is now included in the spectrum of eps . long exposure to peritoneal dialysis solutions is the most cited caused , although it can also develop after renal - transplant , with hyperparathyroidism , , with the use of certain beta - blockers   or after recurrent episodes of peritonitis , , among others . the  two - hit  model has been used to explain the pathophysiology of eps , hypothesizing that a predisposing factor ( injury ) and an initiating factor ( such as an inflammatory stimuli ) are required for eps to develop . from this model we can assume that , in a susceptible patient , it can develop after any peritoneal inflammatory stimuli . eisenberg and colleagues   reported the development of peritoneal inflammation secondary to iodinated contrast agents in guinea - pigs . to the best of our knowledge no cases of eps secondary to intraperitoneal contrast have been reported . clinically , patients with eps can be asymptomatic or may present with symptoms caused by modifications of gastrointestinal transit . nakamoto   divided eps into four clinical and pathological progressive stages , ranging from lack of symptoms in stage 1 to complete bowel obstruction and anorexia characterizing the stage 4 . imaging findings will translate the pathological progression of the disease , with peritoneal calcification predominating in the early stages and the most advanced cases presenting with findings of bowel obstruction such as air - fluid levels , dilated loops or even bowel clustering . on the different imaging techniques , abdominal radiography shows a low accuracy in this diagnosis , being either normal or revealing peritoneal calcification , air - fluid levels or loop dilations . contrast studies can reveal proximal small bowel dilatation , delayed transit time and , in advanced cases ,  cauliflower sign abdominal ultrasound can show peritoneal thickening , loculated peritoneal fluid , peritoneal calcification , adherences , dilated or diminished peristaltic intestinal loops . tarzi created a 22-point score , considering peritoneal thickening , peritoneal calcification , bowel wall thickening , bowel tethering ( 04 points each ) , loculation and bowel dilation ( 03 points ) . the mean score of eps patients was 9 ( 216 ) , comparing to an average score of 1 ( 03 ) in controls patients on peritoneal dialysis . positron emission tomography can show an increased peritoneal uptake but is not able to distinguish from acute peritonitis . in our case , the diagnosis was made by ct , although it could already be suspected by the radiography . our patient ct score is 5 , inferior to the average obtained by tarzi , but matching an early stage of disease that we expected due to the lack of symptoms ( stage 1 ) . the focal peritoneal thickening observed in the most dependent portions of the abdomen might be explained by the longer time exposure of these areas to the peritoneal contrast . laparotomy is indicated in later stages of the disease and shows peritoneal thickening , adhesions , tethering , fibrosis or bowel retraction . no specific treatment has been developed for eps , being proposed the use of total parenteral nutrition , , corticoids , , tamoxifen ,   and surgery with enterolysis of intestinal adhesions for advanced cases , . when presenting with symptoms eps has a high mortality , usually as a result of bowel obstruction , malnutrition and sepsis . we demonstrated an unusual case of peritoneal calcification , in which there was no history of long exposure to peritoneal dialysis solutions . we believe that intraperitoneal iodinated contrast exposure combined with alport syndrome have caused the abnormalities seen . long standing hyperparathyroidism might also have played a role explaining the increased susceptibility of our patient for the development of eps . the authors wish to confirm that there are no known conflicts of interest associated with this publication and there has been no financial support for this work that could have influenced its outcome .