Presentation
Acute right lower quadrant pain and tenderness. No fever, vomiting or leukocytosis.
Patient Data
On ultrasound examination, there is a non-compressible, ovoid hyperechoic mass-like abnormality surrounded by thin hypoechoic lines in the right lower abdomen between cecum and peritoneum, without internal vascularity.
There is a fat-density ovoid structure adjacent to the cecum with a thin high-density rim (hyperattenuating ring sign), surrounding inflammatory fat stranding and thickening of the lateroconal fascia.
There is no adjacent bowel thickening and free fluid. The appendix is also entirely normal.
Yellow arrows show epiploic appendagitis on ultrasound and CT.
Case Discussion
Primary epiploic appendagitis as a cause of acute lower quadrant pain is a rare, self-limiting inflammatory condition that results from torsion or spontaneous venous thrombosis of the epiploic appendages. It is mostly seen in the descending and sigmoid colons, however epiploic appendages are also present in the ascending colon and cecum, but the inflammation of them is rarer. The rarest site is in the transverse colon 1. It is important to distinguish right sided epiploic appendagitis from an acute appendicitis to avoid unnecessary surgery.