PICTORIAL ESSAY   

Il Giornale Italiano di Radiologia Medica 2019 Maggio-Giugno;6(3):250-8

DOI: 10.23736/S2283-8376.19.00168-2

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English, Italian

Epiploic appendagitis: an often unrecognized diagnosis

Monica M. LANZETTA, Irene BALDI, Gloria ADDEO, Diletta COZZI, Ginevra DANTI ✉, Lina BARTOLINI, Costanza VANNINI, Vittorio MIELE

Unit of Radiodiagnostic and Emergency Medicine, Department of Services, Careggi University Hospital, Florence, Italy

Primary epiploic appendagitis (PEA) is an uncommon cause of acute abdominal pain. PEA is generally a benign and self-limiting condition and symptoms mostly resolve over few days with conservative treatment. It is of great importance the differential diagnosis with other causes of acute abdomen which need a surgical treatment, such as diverticulitis and appendicitis, which often could mimic PEA. Primary appendagitis is caused by spontaneous torsion or thrombosis of the central draining vein of a colonic epiploic appendage, whereas secondary forms are consequent to a concomitant inflammation process. A PEA clinically-based diagnosis is virtually impossible, on the other hand computed tomography (CT) demonstrates unique imaging features with a high diagnostic sensitivity. Ultrasounds, which are increasingly used as first acute abdominal pain classification, could shows as well characteristic features of PEA. Both the methods could be used for the PEA recognition, leading to a correct differential diagnosis and avoiding unnecessary surgery. The aims of this pictorial essay were to illustrate the different PEA radiological features and focus on the correct identification of the characteristic imaging and the differential diagnoses with the most important causes of acute abdomen pain: omental infarction, appendicitis and sigmoid diverticulitis.

KEY WORDS: Abdomen, acute; Ultrasonography; Tomography, X-ray computed; Diagnosis, differential