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Emergency Radiology

, Volume 11, Issue 1, pp 9–14 | Cite as

Primary epiploic appendagitis: CT diagnosis

  • Kumaresan Sandrasegaran
  • Dean D. Maglinte
  • Arumugam Rajesh
  • Fatih M. Akisik
Original Article

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.

Keywords

Epiploic appendagitis Colon Inflammation CT 

References

  1. 1.
    Brewer BJ, Golden GT, Hitch DC, Rudolf LE, Wangensteen SL (1976) Abdominal pain. An analysis of 1,000 consecutive cases in a university hospital emergency room. Am J Surg 131:219–223CrossRefPubMedGoogle Scholar
  2. 2.
    Janzon L, Ryden CI, Zederfeldt B (1982) Acute abdomen in the surgical emergency room. Who is taken care of when for what? Acta Chir Scand 148:141–148PubMedGoogle Scholar
  3. 3.
    Rao PM, Rhea JT, Novelline RA, Mostafavi AA, McCabe CJ (1998) Effect of computed tomography of the appendix on treatment of patients and use of hospital resources. N Engl J Med 338:141–146CrossRefPubMedGoogle Scholar
  4. 4.
    Ghahremani GG, White EM, Hoff FL, Gore RM, Miller JW, Christ ML (1992) Appendices epiploicae of the colon: radiologic and pathologic features. Radiographics 12:59–77PubMedGoogle Scholar
  5. 5.
    Rao PM, Wittenberg J, Lawrason JN (1997) Primary epiploic appendagitis: evolutionary changes in CT appearance. Radiology 204:713–717PubMedGoogle Scholar
  6. 6.
    Rioux M, Langis P (1994) Primary epiploic appendagitis: clinical, US, and CT findings in 14 cases. Radiology 191:523–526PubMedGoogle Scholar
  7. 7.
    Rao PM, Rhea JT, Wittenberg J, Warshaw AL (1998) Misdiagnosis of primary epiploic appendagitis. Am J Surg 176:81–85CrossRefPubMedGoogle Scholar
  8. 8.
    Hollerweger A, Macheiner P, Rettenbacher T, Gritzmann N (2002) Primary epiploic appendagitis: sonographic findings with CT correlation. J Clin Ultrasound 30:481–495CrossRefPubMedGoogle Scholar
  9. 9.
    Breda Vriesman AC, Lohle PN, Coerkamp EG, Puylaert JB (1999) Infarction of omentum and epiploic appendage: diagnosis, epidemiology and natural history. Eur Radiol 9:1886–1892CrossRefPubMedGoogle Scholar
  10. 10.
    Molla E, Ripolles T, Martinez MJ, Morote V, Rosello–Sastre E (1998) Primary epiploic appendagitis: US and CT findings. Eur Radiol 8:435–438CrossRefPubMedGoogle Scholar
  11. 11.
    Vinson DR (1999) Epiploic appendagitis: a new diagnosis for the emergency physician. Two case reports and a review. J Emerg Med 17:827–832CrossRefPubMedGoogle Scholar
  12. 12.
    Carmichael DH, Organ CH (1985) Epiploic disorders—conditions of the epiploic appendages. Arch Surg 120:1167–1172PubMedGoogle Scholar
  13. 13.
    McClure MJ, Khalili K, Sarrazin J, Hanbidge A (2001) Radiological features of epiploic appendagitis and segmental omental infarction. Clin Radiol 56:819–827CrossRefPubMedGoogle Scholar
  14. 14.
    Oudenhoven LF, Koumans RK, Puylaert JB (1998) Right colonic diverticulitis: US and CT findings––new insights about frequency and natural history. Radiology 208:611–618PubMedGoogle Scholar

Copyright information

© Am Soc Emergency Radiol 2004

Authors and Affiliations

  • Kumaresan Sandrasegaran
    • 1
  • Dean D. Maglinte
    • 1
  • Arumugam Rajesh
    • 1
    • 2
  • Fatih M. Akisik
    • 1
  1. 1.Department of RadiologyIndiana University Medical CenterIndianapolisUSA
  2. 2.Department of RadiologyLeicester Royal InfirmaryLeicesterUK

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