CT imaging findings of epiploic appendagitis: an unusual cause of abdominal pain
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Giambelluca et al. Insights into Imaging (2019) 10:26 https://doi.org/10.1186/s13244-019-0715-9
PICTORIAL REVIEW
Open Access
CT imaging findings of epiploic appendagitis: an unusual cause of abdominal pain Dario Giambelluca, Roberto Cannella, Giovanni Caruana, Leonardo Salvaggio , Emanuele Grassedonio, Massimo Galia, Massimo Midiri and Giuseppe Salvaggio*
Abstract Epiploic appendagitis is a rare cause of acute abdominal pain, determined by a benign self-limiting inflammation of the epiploic appendages. It may manifest with heterogeneous clinical presentations, mimicking other more severe entities responsible of acute abdominal pain, such as acute diverticulitis or appendicitis. Given its importance as clinical mimicker, imaging plays a crucial role to avoid inaccurate diagnosis that may lead to unnecessary hospitalization, antibiotic therapy, and surgery. CT represents the gold standard technique for the evaluation of patients with indeterminate acute abdominal pain. Imaging findings include the presence of an oval lesion with fat-attenuation surrounded by a thin hyperdense rim on CT (“hyperattenuating ring sign”) abutting anteriorly the large bowel, usually associated with inflammation of the adjacent mesentery. A central high-attenuation focus within the fatty lesion (“central dot sign”) can sometimes be observed and is indicative of a central thrombosed vein within the inflamed epiploic appendage. Rarely, epiploic appendagitis may be located within a hernia sac or attached to the vermiform appendix. Chronically infarcted epiploic appendage may detach, appearing as an intraperitoneal loose calcified body in the abdominal cavity. In this review, we aim to provide an overview of the clinical presentation and key imaging features that may help the radiologist to make an accurate diagnosis and guide the clinical management of those patients. Keywords: Adipose tissue, Epiploic appendices, Abdominal pain, Acute abdomen, Differential diagnosis, Large intestine
Key points Epiploic appendagitis is a rare entity causing acute
abdominal pain, due to a benign, self-limited inflammation of the epiploic appendages. Epiploic appendagitis is a clinical mimicker of other acute abdomen causes, including acute diverticulitis and appendicitis. Imaging features of epiploic appendagitis include fatdensity ovoid lesion, “hyperattenuating ring sign,” mild bowel wall thickening, and “central dot sign.”
* Correspondence: [email protected] Section of Radiological Sciences, University of Palermo, Via del Vespro 127, 90127 Palermo, Italy
Introduction Acute epiploic appendagitis is a rare and easily misdiagnosed cause of acute abdominal pain. It is determined by a benign, self-limiting inflammatory or ischemic damage of the epiploic appendages, or it may be secondary to other inflammatory conditions affecting adjacent abdominal organs. The diagnosis of epiploic appendagitis has a clear clinical relevance and significant implications in patients’ management. In case of acute abdominal pain, this entity is considered a clinica
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