Epiploic appendagitis

Case contributed by David Puyó


Left sided abdominal pain with rebound and guarding.

Patient Data

Age: 35 years
Gender: Male

Ovoid fat density lesion with a high-attenuation margin and surrounding fat stranding, adjacent to the distal descending colon.

Annotated image

Epiploic appendagitis is seen as an ovoid region of fat density with a hyperdense surrounding halo and extensive fat stranding (dotted blue circle).

The IVC is enhanced above the renal arteries due to contrast-enhanced blood flowing out of the kidneys (red arrows) well before blood has had time to reach the legs and pelvis and return via the iliac veins to the infrarenal IVC (green arrow).

On the sagittal image (last image on right), the celiac trunk (CT), the superior mesenteric artery (SMA) and the inferior mesenteric artery (IMA) are all well seen. Irregularity of the anterior aortic wall is due to pulsation of the artery during image acquisition.

Case Discussion

Epiploic appendages are peritoneal outpouchings that arise from the serosal surface of the colon, contain adipose tissue and vessels, and can measure up to 5 cm in length. The inflammation of epiploic appendages can be the result of torsion or venous occlusion 

The differential diagnosis of an intra-abdominal inflammatory fatty lesion on CT includes acute epiploic appendagitis, mesenteric panniculitis, acute diverticulitis, trauma, or an fat-containing neoplasm such as a liposarcoma.

Epiploic appendagitis does not require surgical or medical intervention; it is self-limiting. Pain can be treated with analgesics and subsides in about a week. 

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