Pain in the left lower quadrant.
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Ultrasound transverse and oblique sagittal scans of left lower quadrant showing a well defined hyperechoic fat mass adjacent and anterior to descending and sigmoid colonic junction, just deep to the anterior abdominal wall. No internal vascularity on Doppler evaluation. Adjacent colonic wall appeared normal thickness. No focal fluid collection. The lesion appeared at the point of maximum tenderness.
Epiploic appendagitis is inflammation of mesenteric fat due to torsion of a mesenteric fat lobule ("appendage"). The lesion is seen adjacent to colon and anterior abdominal wall, as pericolonic inflamed fat at the site of maximum tenderness in left lower quadrant. Usually, no internal vascularity or focal fluid collection is associated. Adjacent colon appears normal in mural thickness and gut signature. Most cases are in middle-aged and obese patients, however, this case is a young male.