A toddler presented with right abdominal pain for the past couple of days. Her right abdomen was tender, possibly with rebound tenderness. Labs: CRP 32, very mild leukocytosis without a left shift. The appendix was not appreciated on ultrasonography, so contrast-enhanced CT was done. On CT, the appendix appeared normal and an unexpected omental infarction was deemed the cause of pain. The ultrasound exam was revisited and, sure enough, a thickened, hyperechoic omentum could be seen subjacent to the abdominal wall.

This case underscores the importance of including omental infarction in the differential diagnosis of abdominal pain, especially right lower quadrant pain, in children and searching for it actively on ultrasound, even if it is considered quite uncommon in this population. As it turns out, even young children can become afflicted. Predisposing factors include obesity (as in this case), abdominal trauma, and intestinal hypermotility.