MyPACS.net: Radiology Teaching Files > Case 13109875

previously visited DESCENDING COLONIC EPIPLOIC APPENDIGITIS
Contributed by: Imaging On Call, Radiologist, Imaging On Call, New York, USA.
Patient: 53 year old female
History: 53 yo female presents to the ER with left lower quadrant abdominal pain
Images:[small]larger

Fig. 1: Descending colon: Inflammation of a patch of fat, epiploic appendigitis

Fig. 2: Descending colon: Inflammation of a patch of fat, epiploic appendigitis

Fig. 3: Descending colon: Inflammation of a patch of fat, epiploic appendigitis

Fig. 4: Descending colon: Inflammation of a patch of fat, epiploic appendigitis

Fig. 5: Descending colon: Inflammation of a patch of fat, epiploic appendigitis

Fig. 6: Descending colon: Inflammation of a patch of fat, epiploic appendigitis

Fig. 7: Descending colon: Inflammation of a patch of fat, epiploic appendigitis
Findings: Descending colon: Inflammation of a patch of fat off the antimesenteric (serosal) aspect of colon,
inflamed fatty mass adjacent to the colon with characteristic ring sign.
The characteristic ring-sign corresponds to inflamed visceral peritoneal lining surrounding an infarcted fatty epiploic appendage.
Diagnosis: Epiploic appendigitis
Discussion:

Epiploic appendages are small adipose protrusions from the serosal surface of the colon.
Epiploic appendagitis is thought to occur as a result of spontaneous torsion, ischemia, or inflammation of an epiploic appendage of the colon. The condition presents with acute focal abdominal pain that simulates appendicitis when located in the right lower quadrant or diverticulitis when located in the left lower quadrant.
On helical CT, the lesion shows a characteristic appearance as an ovoid fat-attenuation focus with a hyperattenuating rim associated with the serosal surface of the adjacent colon. Mild inflammatory changes of the surrounding fat may be seen.

Epiploic appendagitis has been reported in approximately 1% of patients clinically suspected of having appendicitis.
It is very important to make a positive diagnosis of this characteristic entity since epiploic appendagitis is a self-limiting disease.
Both US and CT will depict an inflamed fatty mass adjacent to the colon.

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Additional Details:

Case Number: 13109875Last Updated: 02-04-2008
Anatomy: Gastrointestinal (GI)   Pathology: Non-Infectious Inflammatory Disease
Modality: CTAccess Level: Readable by all users
Keywords: epiploic appendigitis

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