Infarction of lesser omental fat

Case contributed by Dr George Harisis

Presentation

SOB, epigastric pain and RUQ/flank pain. Blood in urine. Normal POCUS gallbladder. Previous staghorn calculus. Exclude ureteric calculus.

Patient Data

Age: 55 years
Gender: Female

There are multiple non-obstructing bilateral intrarenal calculi, the largest in the left lower pole measuring 4.5 mm. No obstructing renal tract calculi identified. No hydronephrosis or perinephric stranding.

There is a region of ill-defined fat stranding involving the lesser omentum with some mass effect against the lesser curvature of the stomach. No discrete mass is identified in this region. The stomach and pancreas are otherwise normal in appearance.

Diffuse fatty infiltration of the liver. A small splenunculus is also noted. The liver, spleen, kidneys, adrenals, gallbladder, pancreas are otherwise normal. Mild to moderate fecal loading throughout the colon and rectum. No intra-abdominal or pelvic free fluid.

The imaged lung bases are clear.

No skeletal abnormality identified.

 

Conclusion:

1. Findings are in keeping with a focal infarction of the lesser omentum.

2. Multiple bilateral non-obstructing intrarenal calculi.

Zoomed view of the lesser omentum.

Case Discussion

Fat infarction of the lesser omentum is rare with only a handful of case reports in the literature [1,2]. 

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