Abstract
The objectives of this study are to evaluate the prevalence of left acute colonic diverticulitis (LACD) associated with secondary epiploic appendagitis (SEA) detected by computed tomography (CT); to describe CT features that distinguish LACD associated with SEA from primary epiploic appendagitis (PEA); and to assess the accuracy of CT in diagnosing LACD associated with SEA versus PEA. Institutional review board approval was obtained. We retrospectively identified 46 consecutive patients with LACD between July 2004 and July 2005 and 26 patients with PEA between 2000 and 2005 investigated using multidetector CT. Two radiologists blinded to the final diagnosis reviewed the CT images for findings of LACD-associated SEA or PEA. Each reader classified each CT scan into one of four categories: PEA, LACD-associated SEA, LACD without SEA, and indeterminate. Fisher's exact test and Wilcoxon test were performed to compare the groups. The prevalence of LACD-associated SEA was 71% (33/46) in the LACD group. The accuracy of CT was 100% for diagnosing LACD-associated SEA (33/33), 100% for diagnosing LACD without SEA (13/13), and 96% for diagnosing PEA (25/26). Colon wall thickening, "inflamed diverticulum", extraluminal gas, abscess or phlegmon, multiple paracolic fatty lesions, and a thin hyperattenuated rim were significantly associated with LACD-associated SEA. Neither the dot sign nor parietal peritoneal thickening showed good accuracy for differentiating PEA from LACD-associated SEA. CT is accurate for distinguishing LACD-associated SEA from PEA. The findings that perform best for diagnosing SEA are evidence of diverticulitis, multiple fatty lesions, and a thin hyperattenuated rim.
Similar content being viewed by others
References
Rioux M, Langis P (1994) Primary epiploic appendagitis: clinical, US, and CT findings in 14 cases. Radiology 191:523–526
Singh AK, Gervais DA, Hahn PF, Sagar P, Mueller PR, Novelline RA (2005) Acute epiploic appendagitis and its mimics. Radiographics 25:1521–1534. doi:10.1148/rg.256055030
Molla E, Ripolles T, Martinez MJ, Morote V, Rosello-Sastre E (1998) Primary epiploic appendagitis: US and CT findings. Eur Radiol 8:435–438. doi:10.1007/s003300050408
Son HJ et al (2002) Clinical diagnosis of primary epiploic appendagitis: differentiation from acute diverticulitis. J Clin Gastroenterol 34:435–438. doi:10.1097/00004836-200204000-00010
Dockerty MB, Lynn TE, Waugh JM (1956) A clinicopathologic study of the epiploic appendages. Surg Gynecol Obstet 103:423–433
Rao PM, Wittenberg J, Lawrason JN (1997) Primary epiploic appendagitis: evolutionary changes in CT appearance. Radiology 204:713–717
Singh AK, Gervais DA, Hahn PF, Rhea J, Mueller PR (2004) CT appearance of acute appendagitis. AJR Am J Roentgenol 183:1303–1307
Rao PM, Rhea JT, Wittenberg J, Warshaw AL (1998) Misdiagnosis of primary epiploic appendagitis. Am J Surg 176:81–85. doi:10.1016/S0002-9610(98)00103-2
Danse EM, Van Beers BE, Baudrez V, Pauls C, Baudrez Y et al (2001) Epiploic appendagitis: color Doppler sonographic findings. Eur Radiol 11:183–186. doi:10.1007/s003300000672
Van Breda Vriesman AC, Puylaert JB (2002) Epiploic appendagitis and omental infarction: pitfalls and look-alikes. Abdom Imaging 27:20–28. doi:10.1007/s00261-001-0056-1
Hollerweger A, Macheiner P, Rettenbacher T, Gritzmann N (2002) Primary epiploic appendagitis: sonographic findings with CT correlation. J Clin Ultrasound 30:481–495. doi:10.1002/jcu.10102
McClure MJ, Khalili K, Sarrazin J, Hanbidge A (2001) Radiological features of epiploic appendagitis and segmental omental infarction. Clin Radiol 56:819–827. doi:10.1053/crad.2001.0848
Ghahremani GG, White EM, Hoff FL, Gore RM, Miller JW, Christ ML (1992) Appendaces epiploicae of the colon: radiologic and pathologic features. Radiographics 12:59–77
Legome EL, Belton AL, Murray RE, Rao PM, Novelline RA (2002) Epiploic appendagitis: the emergency department presentation. J Emerg Med 22:9–13. doi:10.1016/S0736-4679(01)00430-9
Rao PM, Rhea JT (1998) Colonic diverticulitis: evaluation of the arrowhead sign and the inflamed diverticulum for CT diagnosis. Radiology 209:775–779
Osada H, Ohno H, Watanabe W, Nakada K, Okada T et al (2008) Multidetector computed tomography diagnosis of primary and secondary epiploic appendagitis. Radiat Med 26:582–586. doi:10.1007/s11604-008-0278-z
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Jalaguier, A., Zins, M., Rodallec, M. et al. Accuracy of multidetector computed tomography in differentiating primary epiploic appendagitis from left acute colonic diverticulitis associated with secondary epiploic appendagitis. Emerg Radiol 17, 51–56 (2010). https://doi.org/10.1007/s10140-009-0822-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10140-009-0822-x