Presentation
Right sided abdominal pain - focal guarding/peritonism in right iliac fossa ?appendicitis.
Patient Data
Inflammatory stranding of omental fat anterior to the right colon containing a whirling pattern of vessels is consistent with omental infarct.
Stranding is distant to the appendix, which has diameter 6mm. No mural thickening in adjacent colon. No bowel obstruction. No free intraperitoneal fluid or gas. No enlarged retroperitoneal or mesenteric lymph nodes.
Multiple calcified gallstones.
Umbilical hernia with a broad hernial orifice and contains fat and bowel without incarceration or obstruction.
Conclusion
Pattern and location of inflammatory stranding is consistent with omental infarct.
Red arrow indicates the region of increased fat attenuation. On the previous scrollable stacks, there is also whirling of the mesenteric vessels.
Case Discussion
Omental infarction is an uncommon diagnosis but one that should be sought for in patients with abdominal without another obvious cause. Surgical/pathological correlation is rare as these patients are usually managed non-operatively.
It is a good habit to run your eye through the intra-abdominal fat, looking for stranding. This allows more focussed interrogation of surrounding structures and may lead to this diagnosis.
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