CT Findings of Primary Epiploic Appendagitis as an Easily Misdiagnosed Entity

Ergelen, Rabia; Asadov, Ruslan; Özdemir, Burcu; Türeli, Derya; Demirbaş, Baha Tolga; Tüney, Davut

doi:10.5505/tjtes.2017.99894

Cited by 9 publications

(9 citation statements)

References 14 publications

(38 reference statements)

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“…The term "epiploic appendagitis" was initially described in 1956 by Lynn et al, and its computed tomography (CT) features were described for the first time in 1986 by Danielson et al [12,[14][15][16]. e179 © Pol J Radiol 2020; 85: e178-e182…”

Section: Introductionmentioning

confidence: 99%

“…EA can be primary or secondary. Primary EA is an inflammatory disease that may arise from a spontaneous torsion causing obstruction of blood flow within the omental appendage, then ischaemia up to a necrosis, or from spontaneous thrombosis of the draining vein and inflammation [13,15,21]. Instead, secondary EA may arise from adjacent inflammatory diseases involving the colonic wall and surrounding mesocolon, such as diverticulitis or appendicitis [1,12].…”

Section: Introductionmentioning

confidence: 99%

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Acute epiploic appendagitis: ultrasound and computed tomography findings of a rare case of acute abdominal pain and the role of other imaging techniques

et al. 2020

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Purpose: Acute epiploic appendagitis (EA) is a relatively rare, benign and local inflammatory disease involving the epiploic appendices. Unlike its mimics, EA is generally a self-limiting inflammatory disease and can be treated conservatively. Case presentation: A 33-year-old Caucasian man presented to our emergency department with a sever and sharp left iliac fossa pain. He underwent abdominal X-ray, ultrasound (US) and computed tomography (CT) evaluations. Conclusion: We illustrate US and CT findings to increase the radiologists' awareness of this condition and to avoid diagnostic delay and unnecessary use of antibiotics, hospitalization and surgery.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Acute epiploic appendagitis: ultrasound and computed tomography findings of a rare case of acute abdominal pain and the role of other imaging techniques

et al. 2020

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“…Clinical presentation may vary among patients. This condition is often an underestimated and overlooked mimicker, easily misdiagnosed with other causes of abdominal pain requiring urgent care or surgical evaluation in emergency department, particularly acute diverticulitis (left iliac pain) or acute appendicitis (right iliac pain) [ 10 , 12 , 19 ]. On physical examination, patients complain of focal non-migratory abdominal pain in the lower abdominal quadrants (left more commonly than right), not exacerbated by physical movement, without significant guarding or rigidity, and in the absence of a palpable mass [ 10 , 11 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

“…The pain is typically circumscribed and the patient may often point his finger on the place where the lesion is situated. Patients may also report postprandial fullness, swelling, vomiting, early satiety, diarrhea, and rarely mild fever [ 10 , 12 , 14 , 18 , 20 , 21 ]. White blood cell count, erythrocyte sedimentation rate, and C-reactive protein levels are within normal range in the majority of patients, while mild leukocytosis may occasionally be observed due to inflammatory response [ 10 – 12 , 14 , 20 , 22 ].…”

Section: Introductionmentioning

confidence: 99%

CT imaging findings of epiploic appendagitis: an unusual cause of abdominal pain

et al. 2019

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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.

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“… 4 In a study of 45 patients with EA, a presumptive clinical diagnosis was acute appendicitis (n=13), acute cholecystitis (n=2), acute diverticulitis (n=19), renal colic (n=7) and ovarian pathology (n=4). 7 Obesity is the only identifiable risk factor associated with EA. 1 2 8 A retrospective CT study of 100 patients with EA versus 100 patients with acute abdomen demonstrated significantly greater abdominal adipose volume, visceral adipose area and subcutaneous adipose area in the EA group.…”

Section: Introductionmentioning

confidence: 99%

Mast cell deposition and activation may be a new explanation for epiploic appendagitis

Weinstock

Kaleem²,

Selby

et al. 2018

BMJ Case Reports

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Epiploic appendagitis is as an acute painful condition of the fat on the outside of the intestine. Thus far, there have been no publications to our knowledge that appendagitis can be caused by mast cells or can be associated with chronic pain. A patient with multisystemic disorders suffered with both chronic and acute attacks of abdominal pain for a year. The worst attack led to surgical resection of an enlarged sigmoid colon epiploic appendage. Careful review of her complex medical history and mast cell stains of gastrointestinal biopsies led to the diagnosis of mast cell activation syndrome. Re-examination of the resected appendage using an immunohistochemical stain demonstrated a high mast cell density which is a new histopathological finding. Treatment of mast cell activation syndrome and other related syndromes led to marked improvement in her health, including all types of chronic abdominal pain.

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CT Findings of Primary Epiploic Appendagitis as an Easily Misdiagnosed Entity

Abstract: BACKGROUND: Primer epiploic appendagitis (PEA) is an uncommon condition.

Cited by 9 publications

References 14 publications

Acute epiploic appendagitis: ultrasound and computed tomography findings of a rare case of acute abdominal pain and the role of other imaging techniques

Acute epiploic appendagitis: ultrasound and computed tomography findings of a rare case of acute abdominal pain and the role of other imaging techniques

CT imaging findings of epiploic appendagitis: an unusual cause of abdominal pain

Mast cell deposition and activation may be a new explanation for epiploic appendagitis

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