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
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.