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Kahveci S, Zitouni S, Abubakar AR, İkizceli T, Ozturk M, Aktürk A, Aksu Y. Primary Epiploic Appendagitis: Not Rare But Rarely Diagnosed Pathology. Curr Med Imaging 2023; 19:1279-1285. [PMID: 36642882 DOI: 10.2174/1573405619666230113122949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 10/06/2022] [Accepted: 11/23/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVE The aim of this study is to determine the clinical and laboratory parameters which may be suggestive of or even pathognomonic for primary epiploic appendagitis (PEA) and to discuss the diagnostic efficacy of ultrasound (US) compared to computed tomography (CT) in patients with PEA. MATERIALS AND METHODS For this retrospective study, 92 patients diagnosed with PEA using US, CT or both modalities were included. All patient symptoms, clinical findings and laboratory parameters were reviewed. The CT and US images of the PEA were evaluated for lesion size and location, the relationship of the lesion to the colon and the distance of the lesion to the skin. RESULTS There were 16 female and 76 male patients in the study group. The mean age was 35 years (range: 38-79 years). Well-localized abdominal pain was the primary symptom in all patients. The mean leukocyte count was 7857±1326 mm-3. The most frequent localization of PEA was sigmoiddescending colon junction (79/92). In patients who were examined by both US and CT, the size of the fatty central core was between 15-48 mm (mean:28.10 mm) and 9-22 mm (mean:15.07 mm) in its long-axis and short-axis diameter, respectively on US, whilst that by CT was between 15-46 mm (mean:26.88 mm) and 9-21 mm (mean:14.40 mm) in its long-axis and short-axis diameter, respectively. In patients who were examined by both US and CT, the mean distance of the lesions to the skin was 20.80 mm and 33.97 mm, respectively. All patients were treated conservatively with complete resolution of symptoms within a week of presentation. CONCLUSION PEA is an unrare self-limiting condition that should be considered in the differential diagnosis of acute abdomen. To support clinicians and radiologists regarding PEA and its clinical, laboratory and radiological findings, targeted sonographic examination - which is radiation and contrast agent-free - could be highly sufficient for the diagnosis of PEA and may prevent unnecessary further imaging and mistreatment.
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Affiliation(s)
- Servet Kahveci
- Department of Radiology, Qatar University Health Center, Doha, Qatar
| | - Soubhi Zitouni
- Department of Radiology, Abu Baker Al Siddiq Health Center, Doha, Qatar
| | | | - Turkan İkizceli
- University of Health Sciences, Haseki Training and Research Hospital, Radiology, Istanbul, Turkey
| | - Mehmet Ozturk
- Department of Radiology, Selcuk University Faculty of Medicine, Division of Pediatric Radiology, Alaeddin Keykubat Yerleşkesi, Akademi Mah. Yeni Istanbul Street. No: 369, Konya, Turkey
| | - Adem Aktürk
- Surp Pırgiç Armenian Hospital Radiology Department, Istanbul, Turkey
| | - Yusuf Aksu
- Nevşehir State Hospital Radiology Department, Nevşehir, Turkey
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Hoegger MJ, Ludwig DR, Zulfiqar M, Raptis DA, Shetty AS. Enhancing the interpretation of unenhanced abdominopelvic CT. Curr Probl Diagn Radiol 2022; 51:787-797. [DOI: 10.1067/j.cpradiol.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/05/2022] [Indexed: 11/22/2022]
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3
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Fat misbehaving in the abdominal cavity: a pictorial essay. Pol J Radiol 2020; 85:e32-e38. [PMID: 32180852 PMCID: PMC7064015 DOI: 10.5114/pjr.2020.93070] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 12/13/2019] [Indexed: 11/27/2022] Open
Abstract
Intra-abdominal fat is abundantly present in both the peritoneum and retroperitoneum. Fat necrosis or inflammation are common findings in abdominal imaging. The most common pathologies that we encounter are epiploic appendagitis, omental infarction, mesenteric panniculitis, and encapsulated fat necrosis. Less common entities that can occur are pancreatic saponification, heterotopic mesenteric ossification, and pseudolipoma of the capsule of Glisson. These entities can mimic more urgent pathologies such as appendicitis, diverticulitis, or malignancies.
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Yazough I, El Bouhadouti H, Mazaz K. [Primitive omental appendagitis: a rare cause of abdominal pain]. Pan Afr Med J 2015; 20:170. [PMID: 26113913 PMCID: PMC4469451 DOI: 10.11604/pamj.2015.20.170.5638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Accepted: 11/13/2014] [Indexed: 11/11/2022] Open
Abstract
Les appendagites sont une cause rare de douleur abdominale chez l'adulte, elles simulent souvent le tableau d'une appendicite aiguë ou une sigmoïdite, le diagnostic est souvent poser par une TDM ou lors d'un acte chirurgicale, le traitement est essentiellement médicale.
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Affiliation(s)
- Issam Yazough
- Faculté de Médecine et de Pharmacie de Fès, Université Sidi Mohammed Ben Abdellah, Département de Chirurgie, CHU Hassan II, Fès, Maroc
| | - Hecham El Bouhadouti
- Faculté de Médecine et de Pharmacie de Fès, Université Sidi Mohammed Ben Abdellah, Département de Chirurgie, CHU Hassan II, Fès, Maroc
| | - Khalid Mazaz
- Faculté de Médecine et de Pharmacie de Fès, Université Sidi Mohammed Ben Abdellah, Département de Chirurgie, CHU Hassan II, Fès, Maroc
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White EK, MacDonald L, Johnson G, Rudralingham V. Seeing past the appendix: the role of ultrasound in right iliac fossa pain. ULTRASOUND (LEEDS, ENGLAND) 2014; 22:104-12. [PMID: 27433203 DOI: 10.1177/1742271x13514385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Acute right iliac fossa pain is a common surgical presentation. The presentation is often non-specific and encompasses a wide differential, which creates a diagnostic challenge. Ultrasound is commonly the initial cross-sectional imaging modality and can be used as a tool to triage patients appropriately; assessing for appendicitis and other salient findings, which may indicate an alternative condition. Additionally, the dynamic nature of this imaging modality enables patient interaction. Following a systematic assessment of the abdomen and pelvis, a more focused interrogation of the right iliac fossa is performed. In this pictorial review, we illustrate the sonographic features of appendicitis and other conditions that can mimic appendicitis in its presentation. This highlights that through a systematic approach, it is possible to distinguish between these different pathologies, enabling clinicians to optimally manage the patient.
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Affiliation(s)
- E K White
- University Hospitals of South Manchester, Wythenshawe Hospital, Manchester, UK
| | - L MacDonald
- University Hospitals of South Manchester, Wythenshawe Hospital, Manchester, UK
| | - G Johnson
- University Hospitals of South Manchester, Wythenshawe Hospital, Manchester, UK
| | - V Rudralingham
- University Hospitals of South Manchester, Wythenshawe Hospital, Manchester, UK
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Hwang JA, Kim SM, Song HJ, Lee YM, Moon KM, Moon CG, Koo HS, Song KH, Kim YS, Lee TH, Huh KC, Choi YW, Kang YW, Chung WS. Differential diagnosis of left-sided abdominal pain: Primary epiploic appendagitis vs colonic diverticulitis. World J Gastroenterol 2013; 19:6842-6848. [PMID: 24187459 PMCID: PMC3812483 DOI: 10.3748/wjg.v19.i40.6842] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 07/16/2013] [Accepted: 09/13/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the clinical characteristics of left primary epiploic appendagitis and to compare them with those of left colonic diverticulitis.
METHODS: We retrospectively reviewed the clinical records and radiologic images of the patients who presented with left-sided acute abdominal pain and had computer tomography (CT) performed at the time of presentation showing radiological signs of left primary epiploic appendagitis (PEA) or left acute colonic diverticulitis (ACD) between January 2001 and December 2011. A total of 53 consecutive patients were enrolled and evaluated. We also compared the clinical characteristics, laboratory findings, treatments, and clinical results of left PEA with those of left ACD.
RESULTS: Twenty-eight patients and twenty-five patients were diagnosed with symptomatic left PEA and ACD, respectively. The patients with left PEA had focal abdominal tenderness on the left lower quadrant (82.1%). On CT examination, most (89.3%) of the patients with left PEA were found to have an oval fatty mass with a hyperattenuated ring sign. In cases of left ACD, the patients presented with a more diffuse abdominal tenderness throughout the left side (52.0% vs 14.3%; P = 0.003). The patients with left ACD had fever and rebound tenderness more often than those with left PEA (40.0% vs 7.1%, P = 0.004; 52.0% vs 14.3%, P = 0.003, respectively). Laboratory abnormalities such as leukocytosis were also more frequently observed in left ACD (52.0% vs 15.4%, P = 0.006).
CONCLUSION: If patients have left-sided localized abdominal pain without associated symptoms or laboratory abnormalities, clinicians should suspect the diagnosis of PEA and consider a CT scan.
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Daghfous A, Bouzaïdi K, Ayari H, Yahmadi A, Zoghlemi A, Rezgui Marhoul L. [Contribution of imaging in the diagnosis of epiploic appendagitis]. Rev Med Interne 2013; 35:565-9. [PMID: 23978699 DOI: 10.1016/j.revmed.2013.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Revised: 06/02/2013] [Accepted: 07/20/2013] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Primary epiploic appendagitis is known to be a rare finding among causes of acute abdomen. Depending on location, it may mimic several disorders such as colonic diverticulitis and acute appendicitis. Diagnosis is sometimes performed during surgery. METHODS This is a retrospective descriptive study. The authors report the contribution of imaging for the diagnosis of appendagitis in seven patients investigated between July 2010 and April 2013 by abdominal and pelvic ultrasound or computed tomography (CT). RESULTS CT scan confirmed the diagnosis in six patients avoiding unnecessary surgery and hospitalization. The seventh patient was a pregnant woman in whom the diagnosis of appendagitis was made during surgery for appendicitis. CONCLUSION Appendagitis is a rare cause of acute abdominal pain. Outcome is favorable with medical treatment only. Abdominal ultrasound and CT are helpful diagnostic tests avoiding useless surgical procedure.
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Affiliation(s)
- A Daghfous
- Service d'imagerie médicale, centre de traumatologie et des grands brûlés, avenue du Grand Mageb Nabeul 8000, Tunis, Tunisie.
| | - K Bouzaïdi
- Service d'imagerie médicale, hôpital Taher Maamouri, Nabeul, Tunisie
| | - H Ayari
- Service de chirurgie générale, centre de traumatologie et des grands brûlés, Tunis, Tunisie
| | - A Yahmadi
- Service d'imagerie médicale, centre de traumatologie et des grands brûlés, avenue du Grand Mageb Nabeul 8000, Tunis, Tunisie; Service d'imagerie médicale, hôpital Taher Maamouri, Nabeul, Tunisie; Service de chirurgie générale, centre de traumatologie et des grands brûlés, Tunis, Tunisie
| | - A Zoghlemi
- Service de chirurgie générale, centre de traumatologie et des grands brûlés, Tunis, Tunisie
| | - L Rezgui Marhoul
- Service d'imagerie médicale, centre de traumatologie et des grands brûlés, avenue du Grand Mageb Nabeul 8000, Tunis, Tunisie
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Lubner MG, Simard ML, Peterson CM, Bhalla S, Pickhardt PJ, Menias CO. Emergent and Nonemergent Nonbowel Torsion: Spectrum of Imaging and Clinical Findings. Radiographics 2013; 33:155-73. [DOI: 10.1148/rg.331125016] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Epiploic appendagitis: is there need for surgery to confirm diagnosis in spite of clinical and radiological findings? World J Surg 2012; 36:441-6. [PMID: 22167263 DOI: 10.1007/s00268-011-1382-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The present retrospective study was conducted to review the authors' experience and describe clinical and radiologic features of epiploic appendagitis (EA), which is an uncommon, self-limiting clinical entity mimicking acute appendicitis and diverticulitis. Awareness of the features of EA would allow a correct diagnosis and avoid unnecessary surgical interventions. METHODS Patients diagnosed as EA in one regional medical center between June 2006 and June 2010 were included. Clinical, laboratory, and imaging features of EA were studied, with particular attention to its unique radiologic appearances. RESULTS Twenty patients (13 men and 7 women; average age 43.2 years) diagnosed with EA were included in the study. Localized abdominal pain without nausea, vomiting, and fever were the major presenting symptoms for all patients. Laboratory blood tests were normal, except in one patient with leukocytosis and two patients with increased serum C-reactive protein (CRP) levels. A noncompressible hyperechoic ovoid mass with hypoechoic border and without central blood flow on Doppler ultrasound (US) was detected in five of six patients. In all patients, the computed tomography (CT) scans revealed an ovoid fatty mass with hyperattenuating rim and disproportionate adjacent fat stranding. Central dot sign, concomitant old infarct, and lobulation were present in 75%, 20%, and 10% of the patients, respectively. All of the patients were treated conservatively. No recurrences occurred during the follow-up period (average: 24.8 months) in 18 (90%) of the patients. CONCLUSIONS In patients with localized abdominal pain without other symptoms, diagnosis of EA should be considered. Recognizing the US and CT features of EA may allow an accurate diagnosis and avoid unnecessary surgery.
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Kamaya A, Federle MP, Desser TS. Imaging manifestations of abdominal fat necrosis and its mimics. Radiographics 2012; 31:2021-34. [PMID: 22084185 DOI: 10.1148/rg.317115046] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Intraabdominal fat is a metabolically active tissue that may undergo necrosis through a number of mechanisms. Fat necrosis is a common finding at abdominal cross-sectional imaging, and it may cause abdominal pain, mimic findings of acute abdomen, or be asymptomatic and accompany other pathophysiologic processes. Common processes that are present in fat necrosis include torsion of an epiploic appendage, infarction of the greater omentum, and fat necrosis related to trauma or pancreatitis. In addition, other pathologic processes that involve fat may be visualized at computed tomography, including focal lipohypertrophy, pathologic fat paucity (lipodystrophies), and malignancies such as liposarcoma, which may mimic benign causes of fat stranding. Because fat necrosis and malignant processes such as liposarcoma and peritoneal carcinomatosis may mimic one another, knowledge of a patient's clinical history and prior imaging studies is essential for accurate diagnosis.
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Affiliation(s)
- Aya Kamaya
- Department of Radiology, Stanford University Medical Center, 300 Pasteur Dr, Room H1307, Stanford, CA 94305, USA
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11
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Kerr S, Hyland R, Rowbotham E, Chalmers A. Postoperative omental infarction following colonic resection. Clin Radiol 2012; 67:134-9. [DOI: 10.1016/j.crad.2011.07.051] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 07/13/2011] [Accepted: 07/27/2011] [Indexed: 11/26/2022]
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Abstract
OBJECTIVE Epiploic appendagitis (EA) is a rare cause of focal abdominal pain in otherwise healthy patients. It may mimic diverticulitis, appendicitis or mesenteric infarction on clinical manifestation. The diagnosis of EA is very infrequent due in part to low awareness by clinical physicians. The aim of this study was to review and describe the clinical presentation and computed tomography (CT) findings of EA. METHODS Twenty-one patients (6 women and 15 men, average age 40 years [range 27-65 years]) were diagnosed with EA by CT between January 2006 and October 2009. The patients' medical records were retrospectively reviewed with regard to their socioeconomic data, characteristics of abdominal pain, associated symptoms, laboratory results, radiological findings and treatment. RESULTS Abdominal pain was the leading symptom. The pain was localized in the left lower quadrant (17 patients, 81.0%), left middle abdomen (2 patients, 9.5%) and right lower quadrant (2 patients, 9.5%), respectively. Leukocytosis (white blood cell > 10 × 10(9) /L) without left shift was found in 6 patients but all patients were afebrile. Characteristic CT findings of paracolonic oval hypodense fat tissue with thickened peritoneal ring and periappendageal fat stranding were all presented in 21 patients, but the central dot sign was presented in only 7 patients. They were all treated was conservative therapy. CONCLUSIONS Epiploic appendagitis is the inflammatory response of an appendage to infarction or spontaneous venous thrombosis. A CT scan provides a definite diagnosis of epiploic appendagitis, thus avoiding unnecessary surgical intervention and antibiotics.
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Affiliation(s)
- Jui-Hao Chen
- Division of Gastroenterology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, China
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Ackerman SJ, Irshad A, Anis M. Ultrasound for pelvic pain II: nongynecologic causes. Obstet Gynecol Clin North Am 2011; 38:69-83, viii. [PMID: 21419328 DOI: 10.1016/j.ogc.2011.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Acute pelvic pain in women is a common presenting complaint that can result from various conditions. Because these conditions can be of gynecologic or nongynecologic origin, they may pose a challenge to the diagnostic acumen of physicians, including radiologists. A thorough workup should include clinical history, physical examination, laboratory data, and appropriate imaging studies, all of which should be available to the radiologist for evaluation. Ultrasound is the primary imaging modality in women with acute pelvic pain because of its high sensitivity, low cost, wide availability, and lack of ionizing radiation, particularly when a gynecologic disorder is suspected as the underlying cause. However, other modalities such as computed tomography (CT) and magnetic resonance imaging (MRI) may be very helpful, especially when a nongynecologic condition is suspected.
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Affiliation(s)
- Susan J Ackerman
- Department of Radiology and Radiological Sciences, Medical University of South Carolina, Charleston, SC 29425, USA.
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Schnedl WJ, Krause R, Tafeit E, Tillich M, Lipp RW, Wallner-Liebmann SJ. Insights into epiploic appendagitis. Nat Rev Gastroenterol Hepatol 2011; 8:45-9. [PMID: 21102533 DOI: 10.1038/nrgastro.2010.189] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Epiploic appendagitis is a rare cause of abdominal pain. Diagnosis of epiploic appendagitis, although infrequent, is easily made with CT or ultrasonography in experienced hands. As reported in the literature, most patients with primary epiploic appendagitis are treated conservatively without surgery, with or without anti-inflammatory drugs. A small number of patients are treated with antibiotics and some patients require surgical intervention to ensure therapeutic success. Symptoms of primary epiploic appendagitis usually resolve with or without treatment within a few days. A correct diagnosis of epiploic appendagitis with imaging procedures enables conservative and successful outpatient management of the condition and avoids unnecessary surgical intervention and associated additional health-care costs. Gastroenterologists and all medical personnel should be aware of this rare disease, which mimics many other intra-abdominal acute and subacute conditions, such as diverticulitis, cholecystitis and appendicitis. This article reviews epiploic appendagitis and includes discussion of clinical findings, pathophysiology, diagnosis and therapeutic possibilities.
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Affiliation(s)
- Wolfgang J Schnedl
- General Practice for General Internal Medicine, Haupstrasse 5, A-8940 Liezen, Austria.
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16
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Conservative management of segmental infarction of the greater omentum: a case report and review of literature. Case Rep Med 2010; 2010. [PMID: 20886031 PMCID: PMC2945678 DOI: 10.1155/2010/765389] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2010] [Accepted: 09/02/2010] [Indexed: 11/18/2022] Open
Abstract
Segmental omental infarction (SOI) is a rare cause of acute abdominal pain. Depending on the site of infarction, it mimics conditions like appendicitis, cholecystitis, and diverticulitis. Before the widespread use of Computed Tomography (CT), the diagnosis was usually made intraoperatively. SOI produces characteristic radiological appearances on CT scan; hence, correct diagnosis using this form of imaging may prevent unnecessary surgery. We present the case of a young woman who was treated conservatively after accurate radiological diagnosis.
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Abstract
Epiploic appendagitis is a benign, self-limited, clinicopathological, and radiological entity that has become more commonly recognized. The clinical presentation resembles a variety of other medical and surgical intra-abdominal conditions and may easily be confused with many of them. Computed tomography (CT) demonstrates characteristic features that help make the diagnosis in most cases, thus avoiding unneeded treatment or surgery. Here, we discuss a case series of five patients who presented with abdominal pain and were ultimately diagnosed with epiploic appendagitis.
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Accuracy of multidetector computed tomography in differentiating primary epiploic appendagitis from left acute colonic diverticulitis associated with secondary epiploic appendagitis. Emerg Radiol 2009; 17:51-6. [DOI: 10.1007/s10140-009-0822-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2009] [Accepted: 05/21/2009] [Indexed: 01/08/2023]
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de Brito P, Gomez M, Besson M, Scotto B, Huten N, Alison D. Fréquence et épidémiologiedescriptive de l’appendicite épiploïque primitive par l’exploration tomodensitométrique des douleurs abdominales de l’adulte. ACTA ACUST UNITED AC 2008; 89:235-43. [DOI: 10.1016/s0221-0363(08)70399-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Cianci R, Filippone A, Basilico R, Storto ML. Idiopathic segmental infarction of the greater omentum diagnosed by unenhanced multidetector-row CT and treated successfully by laparoscopy. Emerg Radiol 2007; 15:51-6. [PMID: 17610001 DOI: 10.1007/s10140-007-0631-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2007] [Accepted: 05/18/2007] [Indexed: 11/30/2022]
Abstract
Idiopathic segmental infarction of the greater omentum is a rare disorder presenting with nonspecific clinical symptoms that may mimic a variety of acute abdominal conditions. We describe the diagnosis and treatment of two patients who had idiopathic infarction of the greater omentum and presented with localized abdominal pain, mimicking acute cholecystitis and acute diverticulitis, respectively. Patients underwent unenhanced multidetector-row computed tomography (CT) examination, which demonstrated the characteristic features of omental infarction, consisting of a heterogeneous density fatty mass, containing hyperattenuating streaks, located in the greater omentum, between the anterior abdominal wall and the colon; a moderate amount of free peritoneal fluid was also present. There were no other pathological abdominal findings. Giving persisting and worsening symptoms, both patients underwent laparoscopy with resection of the necrotic portion of the omentum. Pathology confirmed the preoperative diagnosis. Unenhanced CT allows us to obtain a reliable diagnosis of omental infarction in patients with acute abdominal pain and may help in selecting the appropriate medical or surgical therapy.
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Affiliation(s)
- Roberta Cianci
- Section of Radiological Sciences, Department of Clinical Sciences and Bioimages, G. d'Annunzio University of Chieti, SS. Annunziata Hospital, Via dei Vestini-Colle dell'Ara, 66013 Chieti, Italy
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Rao A, Remer EM, Phelan M, Hatem SF. Segmental omental infarction. Emerg Radiol 2007; 14:195-7. [PMID: 17566801 DOI: 10.1007/s10140-007-0616-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2006] [Accepted: 07/26/2006] [Indexed: 11/29/2022]
Abstract
Acute right-sided abdominal pain is a common presenting symptom in the emergency department. Acute cholecystitis and acute appendicitis are the most likely etiologies for right upper and lower quadrant pain, respectively. However, other differential possibilities include right-sided diverticulitis and perforated colon carcinoma. This case report of an 18-year-old man with segmental omental infarction highlights a much less frequent, self-limited cause of right-sided abdominal pain, which is increasingly identified on computed tomography scans.
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Affiliation(s)
- Anand Rao
- Department of Radiology, Cleveland Clinic, Desk A-21, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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22
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Ng KS, Tan AGS, Chen KKW, Wong SK, Tan HM. CT features of primary epiploic appendagitis. Eur J Radiol 2006; 59:284-8. [PMID: 16580806 DOI: 10.1016/j.ejrad.2006.02.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2005] [Revised: 02/02/2006] [Accepted: 02/17/2006] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The aim of this study is to describe the computed tomography (CT) findings of primary epiploic appendagitis (PEA). METHODS We reviewed the clinical records and CT images of 14 consecutive patients in Singapore who presented with acute abdominal pain from July 2000 to April 2004 and had radiological signs of PEA. RESULTS Hyperattenuated ring with adjacent fat stranding was present in all the patients. The central high attenuation dot was seen in 42.9% (6/14) of the patients. We observed a lobulated fatty mass in 21.4% (3/14) of our patients. All patients recovered during clinical follow-up. CONCLUSIONS We believe the lobulated appearance of PEA is due to two or more, contiguous infarcted epiploic appendages lying in close proximity. This appearance further aids in the diagnosis of PEA and helps differentiates the condition from omental infarction. Recognizing the CT signs of PEA should allow a confident diagnosis and avoid unnecessary surgery.
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Affiliation(s)
- Keng Sin Ng
- Department of Oncologic Imaging, National Cancer Centre, 11 Hospital Drive, Singapore 169610, Singapore.
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Affiliation(s)
- Brian Lugo
- Division of Pediatric Surgery, UCI Medical Center, University of California, Irvine, CA 92868, USA
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Affiliation(s)
- Arumugam Rajesh
- Department of Abdominal Imaging, Indiana University Hospitals, Indianapolis, Ind, USA.
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Bachar GN, Shafir G, Postnikov V, Belenky A, Benjaminov O. Sonographic diagnosis of right segmental omental infarction. JOURNAL OF CLINICAL ULTRASOUND : JCU 2005; 33:76-79. [PMID: 15674838 DOI: 10.1002/jcu.20091] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
PURPOSE The purpose of this study was to identify the characteristic features of omental infarction so that this entity can be differentiated from other acute conditions in the right lower quadrant of the abdomen. METHODS A retrospective review was undertaken. We searched our hospital medical records and found 6 patients with the diagnosis of omental infarction in the last 3 years. Clinical, sonographic, and CT findings at the time of hospital admission and at follow-up were studied. RESULTS In 5 of the 6 patients (83%) sonography demonstrated a moderately hyperechoic, noncompressible ovoid mass located in the omental fat between the umbilicus and the right colon corresponding to the point of maximal tenderness or to the site of a palpable lesion on physical examination. In 1 patient, sonography revealed no abnormalities. In all patients, the diagnosis of omental infarction was confirmed by CT. One patient underwent laparoscopy because of intractable pain; laparoscopy revealed a necrotic segment in the omentum, and pathologic analysis confirmed the original diagnosis. CONCLUSIONS Omental infarction is a benign self-limited disease that can mimic acute abdomen. The diagnosis can be established preoperatively with sonography and CT, which may avoid unnecessary laparotomy.
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Affiliation(s)
- Gil N Bachar
- Department of Radiology, Rabin Medical Center, Beilinson Campus, Petah Tiqva 49100, Israel
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Abstract
OBJECTIVE Our aim was to describe the spectrum of CT findings in patients with acute epiploic appendagitis and also to evaluate the changes seen with this condition. MATERIALS AND METHODS Fifty patients diagnosed with acute epiploic appendagitis seen on contrast-enhanced CT were included in this study. The CT scans of the epiploic appendagitis were evaluated for the presence of colon wall thickening, a focal fatty center, inflammatory changes, location in relationship to the colon, size, and presence or absence of central high density within the fat. In 10 patients, the initial findings were compared with findings of follow-up CT performed between 3 days-21 months after the first CT. RESULTS The most common part of colon involved by acute epiploic appendagitis was the sigmoid colon (31/50), and the most common position was anterior to the colonic lumen (41/50). All 50 patients with acute epiploic appendagitis had a central fatty core surrounded by inflammation. Colon wall thickening was present in only two, and a central high-density focus was noted only in 27 of 50 patients. In 86% (43/50) of patients, the fatty central core was between 1.5 and 3.5 cm in length. The changes seen on follow-up CT varied, including increased density with a decrease in the size of the fatty central core, no change, complete resolution of findings, and minimal residual density. CONCLUSION On CT, acute epiploic appendagitis has a predictable appearance in terms of location, size, and density. The most common finding on CT is a fat-density oval lesion with surrounding inflammation on the anterior aspect of the sigmoid colon. The changes on CT are not predictable in the 2-week to 6-month window.
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Affiliation(s)
- Ajay K Singh
- Division of Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
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Abadir JS, Cohen AJ, Wilson SE. Accurate Diagnosis of Infarction of Omentum and Appendices Epiploicae by Computed Tomography. Am Surg 2004. [DOI: 10.1177/000313480407001005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Segmental infarction of the omentum and epiploic appendages presents with acute abdominal findings that may be confused with a surgical illness. Computed tomography, however, demonstrates a consistent and well-recognized pattern that allows safe, nonoperative treatment. Infarction of omental or mesenteric fat may present clinically as localized peritonitis, mimicking appendicitis, diverticulitis, or cholecystitis. Spontaneous recovery without operation is to be expected if an accurate diagnosis is established. We describe the diagnosis, treatment, and outcome of 15 patients who had infarction of the greater omentum (eight) and epiploic appendage (seven) and presented with localized abdominal pain and tenderness, with six demonstrating regional peritonitis and fever. All underwent CT imaging during their initial evaluation, and 12 of the 15 patients were diagnosed with focal omental or mesenteric fat infarction radiographically and managed nonoperatively. Three patients who had characteristic CT. findings nevertheless underwent operation. All patients had complete resolution of their abdominal pain regardless of treatment. The clinical presentation of infarction of the omental or epiploic appendages may be difficult to differentiate from surgical causes of acute abdominal pain. The characteristic findings on computed tomography are diagnostic and allow safe, conservative management in the majority of patients.
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Affiliation(s)
- Janet S. Abadir
- Department of Surgery, University of California-Irvine, Orange, California
| | - Allen J. Cohen
- Department of Radiology, University of California-Irvine, Orange, California
| | - Samuel E. Wilson
- Department of Surgery, University of California-Irvine, Orange, California
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Sandrasegaran K, Maglinte DD, Rajesh A, Akisik FM. Primary epiploic appendagitis: CT diagnosis. Emerg Radiol 2004; 11:9-14. [PMID: 15278705 DOI: 10.1007/s10140-004-0369-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2004] [Accepted: 05/28/2004] [Indexed: 12/20/2022]
Abstract
The purpose of this study was to analyze the CT signs of primary epiploic appendagitis. A retrospective search of the CT database over 12 months for this diagnosis revealed 11 cases. The clinical findings were recorded. Softcopy CT images were reviewed by two experienced abdominal radiologists (KS, DM) for location of lesion, size, shape, presence of central hyperdense focus, degree of bowel wall thickening, mass effect, and ancillary signs. Abdominal pain was the primary symptom in all patients. Preliminary diagnoses were appendicitis (n=2), diverticulitis (n=5), pancreatitis (n=1), ovarian lesion (n=1), or unknown (n=2). Abdominal examination and white blood cell count were uninformative. CT examination revealed a solitary (n=11), ovoid (n=9) fatty lesion with some soft tissue stranding adjacent to the left colon (n=6), transverse colon (n=3), or right colon (n=2). Central hyperdensity (n=5), mild bowel wall thickening (n=2), and parietal peritoneal thickening (n=4) were also seen. In 4 patients the lesions were not visible on follow-up CT examination performed 23-184 days later. Primary epiploic appendagitis can clinically mimic other, more serious inflammatory conditions. Knowledge of its findings on CT would help the radiologist make the diagnosis and allow a more conservative approach to patient care.
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Affiliation(s)
- Kumaresan Sandrasegaran
- Department of Radiology, Indiana University Medical Center, UH 0279, 550 N. University Blvd., Indianapolis, IN 46202-5253, USA.
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Bretagnol F, Gomez MA, Pautrat K, Scotto B, de Calan L. [Primary epiploic appendicitis: an etiology of acute abdomen revealed by CT scan]. ANNALES DE CHIRURGIE 2003; 128:333-5. [PMID: 12878072 DOI: 10.1016/s0003-3944(03)00094-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Primary epiploic appendicitis are considered to be a rare cause of acute abdomen. We reported 2 cases in which computed tomography CT suggested the diagnosis. Primary epiploic appendicitis shows characteristic CT findings that allow the diagnosis and follow-up. This entity resolves spontaneously and CT helps in avoiding unnecessary surgery.
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Affiliation(s)
- F Bretagnol
- Service de chirurgie digestive, CHU Trousseau, 37044 cedex, Tours, France
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30
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Kruskal JB. Invited Commentary. Radiographics 2003. [DOI: 10.1148/radiographics.23.3.g03ma21684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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