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Abdomen » Peritoneal Cavity
Primary epiploic appendagitis
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Author(s) :
Ravi Kadasne, MD
Presentation This 36-year-old man presented with severe pain in the right paraumbilical region of 2 days duration. There is no fever, vomiting or leucocytosis. There is severe tenderness at one point in the right paraumbilical region. An ultrasound was performed.
Caption: Comparative images of both para-umbilical regions
Description: An oval ill-defined, hyperechoic mass is seen in the right para-umbilical region, just below the muscle layer. There was maximal probe tenderness at that point. The left side is shown for comparison, which is normal.
Caption: Comparative images of the right and left para-umbilical area
Description: The arrows delineate the lesion just described.
Caption: CT scan of the concerned area
Description: CT scan shows an oval rather well-defined mass anterior to the colon. There are streaky densities seen in close proximity to the mass, suggestive of fat stranding. The visualized colon and other structures appear normal.
Caption: Magnified image of the tender area
Description: The oval mass with peri-colonic fat stranding is well appreciated in this image. The mass exhibits mild contrast enhancement and has a mean attenuation value of -55 HU [fat density]
Differential Diagnosis Primary epiploic appendagitis, acute diverticulitis, acute appendicitis, metastasis

Final Diagnosis Primary epiploic appendagitis