Case 16
History:
45 year old male with acute left lower quadrant pain
Findings:
Contrast-enhanced CT scan shows an oval shaped fat-density lesion with surrounding inflammation abutting lateral aspect of the descending colon.
Diagnosis:
Epiploic appendagitis (EA)
Discussion:
Epiploic appendages are peritoneal outpouchings that arise from the serosal surface of the colon and contain adipose tissue and vessels. Patients with epiploic appendagitis (EA) most commonly present with localized abdominal pain, more commonly on the left. The average patient is about 40 years old. Symptoms can often mimic acute appendicitis, diverticulitis, or cholecystitis. Initial labs are usually normal. The most common CT appearance is an oval lesion less than 5 cm in diameter fat attenuation abutting the anterior colonic wall.
The clinical management of acute appendagitis includes conservative treatment with pain medication. It is important to be aware of the evolutionary follow-up CT findings of acute appendagitis because these findings may persist for several months and mimic the diagnosis of acute epiploic appendagitis in the absence of a prior comparison study or suggestive clinical history.
References:
- Horvath E, Majlis S, Seguel S, et al. Primary epiploic appendagitis: clinical and radiological diagnosis. Rev Med Chil 2000;128:601 -607
- Birjawi GA, Haddad MC, Zantout HM, Uthman SZ. Primary epiploic appendicitis: a report of two cases. Clin Imaging2000; 24:207 -209
