Acute epiploic appendagitis

Case contributed by Dr Naim Qaqish

Presentation

Acute left lower quadrant pain.

Patient Data

Age: 25 years
Gender: Male
Ultrasound

ABDOMEN AND PELVIC U/S.

There is a hyperechoic mass-like abnormality in the left lower abdomen measuring 3 x 3 cm, non-compressible and without internal vascularity. It appears related to the bowel in the region likely due to epiploic appendagitis. CT scan is recommended for confirmation.

The rest of examination was unremarkable apart from diffuse fatty infiltration of the liver. (images are not included).

CT

ABDOMEN AND PELVIS CT SCAN WITH IV & ORAL CONTRAST:

Fat density structure is seen anterior to sigmoid-descending colon junction with surrounding focal fat stranding. Associated with overlying peritoneal thickening surrounding the previously described structure "hyperattenuating ring sign "and minimal wall thickening of the adjacent colon, indicating epiploic appendagitis.

Fatty liver without focal lesion.

Normal portal vein

No biliary dilatation or calcified gall stones.

Normal spleen, pancreas and both kidneys.

No adrenal masses or retroperitoneal lymphadenopathy.

Normal urinary bladder and prostate.

No fluid collections.

The appendix appears aerated measuring around 8 mm without surrounding inflammatory changes.

Case Discussion

This 25 year old man presented through ER with left lower quadrant pain. Along with initial labs abdomen and pelvis ultrasound was requested, showed hyperechoic mass at site of patients complaint and guarding at this area. It appeared non-compressible without internal vascularity. No associated abdomen or pelvis free fluid. CT scan was advised by our radiology department and confirmed fat density lesion at typical location anterior to sigmoid-descending colon junction findings are those of epiploic appendagitis. Follow-up scan was also advised.

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Case information

rID: 83430
Published: 23rd Oct 2020
Last edited: 23rd Oct 2020
Inclusion in quiz mode: Included