Primary epiploic appendagitis

The clinical presentation of primary epiploic appendagitis can mimic diverticulitis or appendicitis. Review of the pathologically confirmed cases in the English literature shows the majority of cases to arise from the sigmoid colon. Pathognomonic findings by computed tomography impact patient management, and it is thus important to recognize these in patients imaged in the emergency setting. Electronic Publication     

Primary epiploic appendagitis: CT manifestations

Inflammation of an epiploic appendage is considered to be a rare cause of acute abdomen. Recently, it has been reported that typical computed tomography (CT) findings of primary epiploic appendagitis (PEA) provide a definitive diagnosis in most of the cases. However, since these papers are only few, they are easily overlooked by the practicing radiologists. Our purpose is to add four new cases to the existing literature and to perform a review of the literature.     

Primary epiploic appendagitis: CT diagnosis

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.     

Primary epiploic appendagitis: US and CT findings

A retrospective review is presented of seven cases of epiploic appendagitis, with surgical confirmation in one case. The main clinico-analytical data and the US and CT findings are described, as well as the histopathologic features in the sole case that underwent surgical resection. We also calculated the frequency of this entity in patients undergoing emergency abdominal US on clinical suspicion of diverticulitis. In all seven cases the clinico-analytical evidence was nonspecific (localized acute abdominal pain and slight leukocytosis), mimicking in six cases the clinical presentation of sigmoid diverticulitis and in one case that of acute appendicitis. US imaging findings were characteristic: a hyperechoic mass localized under the point of maximum pain, adjacent to the anterior peritoneal wall and fixed during deep breathing. In none of the cases did color Doppler US show flow. CT findings were also typical and showed a mass with a peripheral hyperattenuated rim surrounding an area of fatty attenuation. Overall 7.1 % of patients investigated to exclude sigmoid diverticulitis finally showed findings of primary epiploic appendagitis. Primary epiploic appendagitis thus shows characteristic US and CT findings that allow its diagnosis and follow-up. This entity is much more frequent than previously reported, especially in patients referred for US to exclude sigmoid diverticulitis. Received: 1 April 1997; Revision received 19 August 1997; Accepted 2 September 1997     

Acute epiploic appendagitis: CT findings in 33 cases

Acute epiploic appendagitis (AEA) is a benign self-limiting process presenting with acute abdominal pain often misdiagnosed clinically as either diverticulitis or appendicitis, but which has a pathognomonic CT appearance. The CT findings in 33 adult patients diagnosed by CT over a 33-month period as having AEA were retrospectively reviewed. The study group included 24 men and 9 women, with a mean age of 44.6 years. The mean age of the male patients was lower than that of the female patients, 40.9 vs 54.7 years. All patients presented with acute abdominal pain, mainly in the left (n=21) and right (n=9) lower quadrants, with localized tenderness in all patients and peritoneal irritation in 15 of them. Low-grade fever was found in 8 patients and mild leukocytosis in 16. Characteristic CT findings of an oval fatty mass with central streaky densities and surrounded by mesenteric stranding adjacent to the serosal surface of the colon were seen in all cases. Additional findings included mural thickening of the juxtaposed colon in 16 patients and peritoneal fluid in 7. One patient underwent surgery on the basis of an erroneous diagnosis of acute appendicitis. As CT is often used nowadays to evaluate various acute abdominal complaints, it may be the first imaging modality by which AEA is diagnosed. AEA should be included in the differential diagnosis in young male patients with localized left lower abdominal pain and tenderness. Electronic Publication     

Caecal epiploic appendagitis: an unlikely occurrence

AIM: To determine whether epiploic appendagitis occurs in the caecum. METHODS: From 2000-2006, 58 cases with classic computed tomography (CT) features of acute epiploic appendagitis (focal round or oval fat density immediately adjacent to the colon with surrounding oedema and stranding, with or without a central area of high attenuation) were identified from a radiology information system and available for review on the picture archiving and communication system (PACS). Cases were assigned to one of six colonic segments: rectum, sigmoid, descending colon, transverse colon, ascending colon, and caecum. The Blyth-Still-Casella procedure was used to derive an exact upper bound on the likelihood of epiploic appendagitis occurring within the caecum. RESULTS: Twenty-eight cases occurred in the sigmoid colon, 16 in the descending colon, four in the transverse colon, and 10 in the ascending colon. No cases of acute epiploic appendagitis were identified in the caecum. Four cases of prospectively dictated caecal epiploic appendagitis were identified from the database. Retrospective review of these cases showed two cases to be epiploic appendagitis of the ascending colon. The third case demonstrated peritoneal thickening without evidence of an inflamed epiploic appendage. The fourth case was caecal diverticulitis. Based on these findings there is 95% confidence that no more than 4.6% of patients with epiploic appendagitis will show this condition within the caecum. CONCLUSION: In the authors' experience, epiploic appendagitis does not occur in the caecum. Therefore, it is an unlikely cause for an inflammatory process in this region and other conditions should be considered.     

原发性肠脂垂炎的超声诊断

原发性肠脂垂炎是由于扭转或自发的静脉血栓引起的缺血所致[1,2]。因为它和憩室炎,阑尾炎有相似的临床表现[2,4],所以正确诊断是非常重要的,可避免不必要的手术。1材料与方法回顾性分析2003年~2006年超声检查并经手术与随访证实的原发性型肠脂垂炎7例,男5例,女2例,平均年龄37岁。均以腹疼就诊,右侧腹疼痛3例,左侧腹疼痛4例,疼痛时间3~5天不等,无发烧、恶心、呕吐。使用东芝6000,飞利浦HDI-5000,探头频率3~12MHz,重点检查患者疼痛最明显的部位,观察病变的大小、形态、内部回声与周围的关系。2结果超声显示的包块中,其中1例中心为强回声,周…     

CT features of primary epiploic appendagitis

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.     

Acute epiploic appendagitis in hernia sac: CT appearance

We describe an unusual cause of acute abdomen due to acute epiploic appendagitis located within an incisional hernia sac. The contrast-enhanced CT showed an oval fat density structure with surrounding inflammation in the transverse mesocolon. The contrast-enhanced CT findings of the inflammation of appendices epiploicae of the transverse colon were diagnostic in this case.     

Accuracy of multidetector computed tomography in differentiating primary epiploic appendagitis from left acute colonic diverticulitis associated with secondary epiploic appendagitis

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.     

Radiological features of epiploic appendagitis and segmental omental infarction

Epiploic appendagitis and segmental omental infarction are more frequently encountered with the increased use of abdominal ultrasound and Computed tomography (CT) in the radiological assessment of the patient who presents clinically with acute abdominal pain. Recognition of specific imaging abnormalities enables the radiologist to make the correct diagnosis. This is important, as the appropriate management of both conditions is often conservative. Follow-up imaging features correlate with clinical improvement.     

Multidetector computed tomography diagnosis of primary and secondary epiploic appendagitis

Purpose  The aim of this study was to evaluate the epiploic appendages in patients with acute abdomen using multidetector computed tomography (MDCT) and to determine the incidence of primary and secondary epiploic appendagitis (EA). Materials and methods  A radiologist reviewed MDCT images from 1338 patients with acute abdomen for visible epiploic appendages. Two radiologists then reviewed the MDCT images showing inflamed epiploic appendages and diagnosed primary EA, secondary EA, or other conditions by consensus. The CT criteria for primary EA are a round or oval pericolonic fatty lesion with a hyperattenuated rim and adjacent fat stranding, without other causes of inflammation. Secondary EA is diagnosed if an epiploic appendage is found to be due to inflammation from other inflammatory entities. Results  Epiploic appendages were identified in 19 patients. Four patients (0.3%) had a retrospective CT diagnosis of primary EA. Twelve patients (0.9%) had a retrospective CT diagnosis of secondary EA (primary condition was diverticulitis in 10 patients and inflammatory bowel disease in 2 patients). The remaining three patients had calcification of an epiploic appendage suggestive of old EA. Conclusion  Primary EA should be included in the differential diagnosis of acute abdomen. Occasionally, inflammation of the epiploic appendages is secondary to other inflammatory conditions.     

原发性肠脂垂炎的CT表现及临床意义

目的 分析原发性肠脂垂炎（PEA）的CT特点及临床应用价值.方法 回顾性分析2008年5月～2013年7月经诊断为PEA的完整资料.主要分析肿块的部位、大小、形态、密度及周围情况.结果 肿块位于乙状结肠旁10例,回盲部旁6例,升结肠旁2例,降结肠旁2例,结肠肝曲旁1例.肿块呈圆形、椭圆形.肿块大小1.0cm×1.1cm～2.8cm×3.2cm,平均2.1cm×2.4cm.CT表现早期3例,脂肪肿块内有云絮状高密度,边缘较薄环壁,增强后环壁轻度强化,肿块内絮状、条索状强化.进展期12例,肿块内高低混杂密度,环壁较厚,边缘清楚,环壁中等强化.恢复期6例,肿块缩小,形态不规则,壁变薄,环壁轻度强化.12例进展期中,周围系膜肿胀12例,附近结肠壁轻度增厚5例,小肠袢受压2例,周围淋巴结肿大4例.21例PEA中,9例经手术病理证实,12例影像学检查,并随访病变缩小或消失.结论 CT对PEA的定性诊断有重要价值,对指导临床治疗有重要意义.     

超声与CT诊断原发性肠脂垂炎的比较

目的:分析原发性肠脂垂炎(PEA)的超声和CT影像特点,比较两者的诊断价值。方法:36例PEA中,男30例,女6例。所有病例均行超声和CT检查,比较两者诊断符合率。结果:PEA超声特点表现为结肠壁旁卵圆形、不可压缩的高回声团块,且与腹壁有粘连;CT特征表现为结肠壁旁"戒指"样或卵圆形脂肪性密度。超声诊断PEA符合率为88.9%,CT诊断符合率为91.7%,两者差异无统计学意义(2=0.06,P>0.10)。结论:超声诊断PEA是首选影像学检查手段,CT可作为补充。     

MSCT对原发性肠脂垂炎的检查价值

目的 探讨原发性肠脂垂炎（PEA）的CT特征,MSCT的检查价值.方法 对12例具有完整MSCT扫描资料并随访证实的原发性肠脂垂炎病例进行回顾性分析.12例均行全腹平扫,其中2例行增强扫描.结果 10例病灶位于直乙状结肠转折处,1例位于回盲部,1例位于降结肠;12例卵圆形脂肪密度病灶均可见边缘高密度环,11例病灶中心可见高密度影;9例病灶周围可见继发性炎性改变,其中5例可见邻近腹膜增厚,但均未见邻近肠壁增厚及周围积液;2例增强扫描病灶边缘的高密度环及邻近增厚的腹膜可见强化.4～10周后CT随访,12例病灶均自行消退.结论 边缘高密度环征、中心高密度影和周围继发性炎性改变为原发性肠脂垂炎的特征性CT表现,MSCT能清楚显示病灶细节特征及毗邻结构,对原发性肠脂垂炎的诊断有决定性意义.