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

Abstract

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.

Keywords: abdominal pain; acute abdomen; computed tomography (CT); emergency radiology; epiploic appendagitis; ultrasound (US).

Figure 1

Abdominal X-ray showed no pathological air-fluid levels and no free subphrenic gas

Figure 2

Abdominal US image of the left lower quadrant showed a reactive bowel wall thickening of the descending and the sigmoid colon with inflammatory changes in the pericolonic fat, which appeared as an adjacent, oval, non-compressible, hyperechoic mass, without internal vascularity, surrounded by a subtle hypoechoic line, and at least three perivisceral lymph node formations that were likely to be reactive

Figure 3

Abdominopelvic computed tomography with intravenous and oral contrast agents (axial and coronal scans) showed a moderate reactive wall thickening of the descending and the sigmoid colon and a non-enhancing adjacent fat-density ovoid structure with high-density rim and surrounding inflammatory fat stranding