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Acute
   Epiploic
 Appendagitis
  CT findings




Dr Arun Gupta
Director
Imaging Deptt
Dr Rakhee Gupta     Young male patient presented with
Dr Nitu Narula      pain Right lumbar & flank region.
Dr Ritesh Mahajan       CECT abdomen was done .
Dr R K Gandhi
Epiploic
appendages
are peritoneal
outpouchings
that arise
from the
serosal
surface of the
colon, contain
adipose tissue
and
vessels, and      The inflammation of epiploic
can be up to 5   appendages can be the result of
cm in length.     torsion or venous occlusion.
IMPORTANT
CT FINDING
A fatty central
core abutting
the colon wall
with
surrounding
inflammatory
changes and a
base
narrower          FATTY CENTRE
than the          INFLAMMATORY CHANGES
equator.          BASE NARROWER THAN EQUATOR
ACUTE EPIPLOIC APPENDAGITIS

 Acute epiploic appendagitis is an uncommon cause of
    abdominal pain .
    The diagnosis primarily relies on cross-sectional imaging and
    is made most often on CT.
   Clinically, it is most often mistaken for acute diverticulitis
   When acute epiploic appendagitis involves the cecum, it may
    be mistaken clinically for acute appendicitis.
   Because of the benign self-limiting course of this condition, it
    is important to recognize and understand its various
    manifestations as it mimics a surgical abdomen.
   Patients with epiploic appendagitis most commonly present
    with localized abdominal pain, more commonly on the left.
    The presenting clinical symptoms of epiploic appendagitis are
    nonspecific, leading to clinical misdiagnosis .
ACUTE EPIPLOIC APPENDAGITIS- CT FINDINGS


 CT scans of the Epiploic appendagitis is evaluated
 for the presence of
    Colon wall thickening
    Focal fatty center of the lesion
    Inflammatory changes around the fatty central core
    Location in relation to the colon
    Size
    Presence or absence of central high density within the
     fat representing thrombosed vessels

  PRESENCE OR ABSENCE OF LEUKOCYTOSIS IS ALSO
                   ASSESSED.
ACUTE EPIPLOIC APPENDAGITIS- CT FINDINGS

The most common CT appearance of acute
  epiploic appendagitis is :
 The presence of 1.5- to 3.5-cm-diameter
  fat-density lesion with surrounding
  inflammatory changes abutting the wall
  of the adjacent colon.
 Involvement of the proximal colon is
  less common, although not unusual.
 Although the presence of a central high-
  attenuation focus within the fat is a
  helpful finding in making the
  diagnosis, its absence does not exclude
  the diagnosis of acute epiploic
  appendagitis.
 The high-density central focus within
  the fat is believed to represent a
  thrombosed vessel within the inflamed
  appendix epiploica.
AXIAL IMAGES
                             FAT DENSITY CENTRE WITH
BASE OF INFLAMMATION IS    SURROUNDING HYPERDENSE RIM
 SMALLER THAN EQUATOR     AND INFLAMMATION ABUTTING THE
                                 ASCENDING COLON
AXIAL IMAGES

 FATTY CORE    ADJACENT INFLAMMTORY
APPRECIATED         STRANDING
CORONAL REFORMATIONS
Differential Diagnosis

 The differential diagnosis of an Inflammatory fatty lesion
 on CT includes
    Acute epiploic appendagitis
    Mesenteric panniculitis
    Acute diverticulitis
    Trauma
    Omental neoplasm such as a liposarcoma.
    Omental infarction can have an appearance similar to that
     of epiploic appendagitis, it lacks the hyperdense ring that is
     seen in epiploic appendagitis. The CT features of omental
     infarction typically consist of a right lower quadrant well-
     circumscribed nonenhancing oval soft-tissue mass that is
     located deep relative to the anterior abdominal muscles.
TO
SUMMARIZE, RADI
   OLOGICAL
  ASSESMENT
   INCLUDES
Presence of colon
wall thickening,
Focal fatty center
Inflammatory
changes
Location in
relationship to the
colon
Size, and presence     INFLAMMTION VENTRAL TO ASCENDING COLON.
or absence of          FOCAL FATTY CENTRE
central high density   SUBCENTIMETRE HIGH ATTENUATION AREAS IN
within the fat.
                       THE CORE OF THE INFLAMMATION FOCUS
CT findings usually    ( Thrombosed Vessels)
resolve by 6 months    COLONIC WALL THICKENING
REFERENCES

•G B A H R E M A N I G G , W H I T E M , H O F F F L , E T A L :
APPENDICES EPIPLOICAE OF THE COLON:
RADIOLOGIC AND PATHOLOGIC FEATURES.
RADIOGRAPHICS 12: 59-77, 1992.

•S I N G H A K , G E R V A I S D A , H A H N P F E T A L : C T
APPEARANCE OF ACUTE APPENDAGITIS. AJR
183:1303-7, 2004.

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Acute epiploeic appendagitis.pptx2

  • 1. Acute Epiploic Appendagitis CT findings Dr Arun Gupta Director Imaging Deptt Dr Rakhee Gupta Young male patient presented with Dr Nitu Narula pain Right lumbar & flank region. Dr Ritesh Mahajan CECT abdomen was done . Dr R K Gandhi
  • 2. Epiploic appendages are peritoneal outpouchings that arise from the serosal surface of the colon, contain adipose tissue and vessels, and The inflammation of epiploic can be up to 5 appendages can be the result of cm in length. torsion or venous occlusion.
  • 3. IMPORTANT CT FINDING A fatty central core abutting the colon wall with surrounding inflammatory changes and a base narrower FATTY CENTRE than the INFLAMMATORY CHANGES equator. BASE NARROWER THAN EQUATOR
  • 4. ACUTE EPIPLOIC APPENDAGITIS  Acute epiploic appendagitis is an uncommon cause of abdominal pain .  The diagnosis primarily relies on cross-sectional imaging and is made most often on CT.  Clinically, it is most often mistaken for acute diverticulitis  When acute epiploic appendagitis involves the cecum, it may be mistaken clinically for acute appendicitis.  Because of the benign self-limiting course of this condition, it is important to recognize and understand its various manifestations as it mimics a surgical abdomen.  Patients with epiploic appendagitis most commonly present with localized abdominal pain, more commonly on the left. The presenting clinical symptoms of epiploic appendagitis are nonspecific, leading to clinical misdiagnosis .
  • 5. ACUTE EPIPLOIC APPENDAGITIS- CT FINDINGS  CT scans of the Epiploic appendagitis is evaluated for the presence of  Colon wall thickening  Focal fatty center of the lesion  Inflammatory changes around the fatty central core  Location in relation to the colon  Size  Presence or absence of central high density within the fat representing thrombosed vessels PRESENCE OR ABSENCE OF LEUKOCYTOSIS IS ALSO ASSESSED.
  • 6. ACUTE EPIPLOIC APPENDAGITIS- CT FINDINGS The most common CT appearance of acute epiploic appendagitis is :  The presence of 1.5- to 3.5-cm-diameter fat-density lesion with surrounding inflammatory changes abutting the wall of the adjacent colon.  Involvement of the proximal colon is less common, although not unusual.  Although the presence of a central high- attenuation focus within the fat is a helpful finding in making the diagnosis, its absence does not exclude the diagnosis of acute epiploic appendagitis.  The high-density central focus within the fat is believed to represent a thrombosed vessel within the inflamed appendix epiploica.
  • 7. AXIAL IMAGES FAT DENSITY CENTRE WITH BASE OF INFLAMMATION IS SURROUNDING HYPERDENSE RIM SMALLER THAN EQUATOR AND INFLAMMATION ABUTTING THE ASCENDING COLON
  • 8. AXIAL IMAGES FATTY CORE ADJACENT INFLAMMTORY APPRECIATED STRANDING
  • 10. Differential Diagnosis  The differential diagnosis of an Inflammatory fatty lesion on CT includes  Acute epiploic appendagitis  Mesenteric panniculitis  Acute diverticulitis  Trauma  Omental neoplasm such as a liposarcoma.  Omental infarction can have an appearance similar to that of epiploic appendagitis, it lacks the hyperdense ring that is seen in epiploic appendagitis. The CT features of omental infarction typically consist of a right lower quadrant well- circumscribed nonenhancing oval soft-tissue mass that is located deep relative to the anterior abdominal muscles.
  • 11. TO SUMMARIZE, RADI OLOGICAL ASSESMENT INCLUDES Presence of colon wall thickening, Focal fatty center Inflammatory changes Location in relationship to the colon Size, and presence INFLAMMTION VENTRAL TO ASCENDING COLON. or absence of FOCAL FATTY CENTRE central high density SUBCENTIMETRE HIGH ATTENUATION AREAS IN within the fat. THE CORE OF THE INFLAMMATION FOCUS CT findings usually ( Thrombosed Vessels) resolve by 6 months COLONIC WALL THICKENING
  • 12. REFERENCES •G B A H R E M A N I G G , W H I T E M , H O F F F L , E T A L : APPENDICES EPIPLOICAE OF THE COLON: RADIOLOGIC AND PATHOLOGIC FEATURES. RADIOGRAPHICS 12: 59-77, 1992. •S I N G H A K , G E R V A I S D A , H A H N P F E T A L : C T APPEARANCE OF ACUTE APPENDAGITIS. AJR 183:1303-7, 2004.