Carcione, G

CARCIONE, Paola

GALFANO, Maria Cristina

GALIA, Massimo

LA TONA, Giuseppe

LO RE, Giuseppe

MANIACI, Giuseppe

MIDIRI, Massimo

SALERNO, Sergio

Archivio istituzionale della ricerca - Università di Palermo

Page 1 of 8Role of MSCT scan in management of patients with primaryepiploic appendagitis; our experiencePoster No.: C-0597Congress: ECR 2013Type: Scientific ExhibitAuthors: P. Carcione, G. Lo Re, G. Maniaci, G. Carcione, M. C. Galfano, M.Galia, G. La Tona, S. Salerno, M. Midiri; Palermo/ITKeywords: Abdomen, Gastrointestinal tract, Emergency, CT, Complications,InflammationDOI: 10.1594/ecr2013/C-0597Any information contained in this pdf file is automatically generated from digital materialsubmitted to EPOS by third parties in the form of scientific presentations. Referencesto any names, marks, products, or services of third parties or hypertext links to third-party sites or information are provided solely as a convenience to you and do not inany way constitute or imply ECR's endorsement, sponsorship or recommendation of thethird party, information, product or service. ECR is not responsible for the content ofthese pages and does not make any representations regarding the content or accuracyof material in this file.As per copyright regulations, any unauthorised use of the material or parts thereof aswell as commercial reproduction or multiple distribution by any traditional or electronicallybased reproduction/publication method ist strictly prohibited.You agree to defend, indemnify, and hold ECR harmless from and against any and allclaims, damages, costs, and expenses, including attorneys' fees, arising from or relatedto your use of these pages.Please note: Links to movies, ppt slideshows and any other multimedia files are notavailable in the pdf version of presentations.www.myESR.orgPage 2 of 8PurposePrimary epiploic appendagitis (PEA) is a rare case of acute abdomen pain and can beoften misdiagnosed with diverticulitis or appendicitis, because of the absence of specificsymptoms.Because of the benign self-limited course of PEA, it is important to recognise andunderstand its manifestations, in order to avoid unnecessary surgery and hospitalization.The diagnosis of this condition relies firstly on multidetector CT ( MDCT). In this posterwe illustrate the spectrum of CT findings in patient with PEA and its complications.Our aim is to individuate tipical CT findings of PEA which can help radiologists recognizethis condition by using non invasive diagnosis, thus allowing the selection of theappropriate way of management .Methods and MaterialsSeven patients (2 females, 5 males; range 12 to 60 years) with acute abdominal painwere included in our study. All patients underwent MDCT scan (16 rows for 4 patientsand 128 rows for 3 patients) before and after iodinated contrast medium administration(320 mgI\ml).Images were evaluated at dedicated work-station using axial images and multi-planarreconstructions (MPR).The CT scans of the epiploic appendagitis were evaluated for a focal fatty center, thepresence of colon wall thickening, inflammatory changes, location in relationship to thecolon, size and presence or absence of central high density within the fat.Six patients were managed conservatively with oral FANS and antibiotics and recoveredin about 10 days. One patient showed an abscess diagnosed as a complicated PEA aftersurgeryResultsEpiplooic appendages are fatty appendages originating in two rows parallel to the toeniacoli. Their limited blood supply together with their pedunculated shape and excessivemobility make them prone to torsion and ischemic infarctions.Page 3 of 8PEA refers to inflammation in the epiplooic appendages caused by spontaneous torsionof its vascular stalk.All patients came to our attention with acute abdominal pain: 5 patients had left lowerquadrant pain, 2 patients right lower quadrant pain. All patients were afebrile andonly 4 showed mild leukocitosis. Phisical examination revealed a localized abdominaltenderness in all patients• In six of our patients the inflamed epiploic appendage on CT appears asa 1-4 cm ovoid pericolic lesion with fat density surrounded by a 2-3 mmhyperdense rim, sign of inflamed visceral peritoneal covering (fig.1): thisrepresents the diagnostic sign of PEA. Other findings were asimmetric wallthickening of the adjacent side of the colon and fat stranding (fig. 2).These patients were treated conservatively with oral FANS and antibiotics.• One patient showed at first MDCT a multiloculated mass next to the rightflexure of the colon (fig. 3) that was diagnosed as an abscess arising from acomplicated PEA after surgery.Images for this section:Page 4 of 8Fig. 1: Male patient, 55 y.o. Unenhanced MDCT axial image shows clearly an ovoidpericolic lesion with hyperdense rim and fat stranding in the left lower quadrant.Page 5 of 8Fig. 2: Female patient, 60 y.o. Enhanced MDCT axial image showing an ovoid lesionwith fat density surrounded by a hyperdense rim in the left lower quadrant, next to thecolonic wall.Page 6 of 8Fig. 3: Female patient, 12 y.o. Enhanced MDCT coronal image showing a multi-loculatedmass with irregular border, enhancing layer, internal dissepiments and fluid content nextto the right flexure of the colon. This mass was diagnosed as an abscess arising froma PEA after surgery.Page 7 of 8ConclusionPEA is very rare and because of non specific symptoms and signs, it is oftenmisdiagnosed: today this condition can be well recognised with a good confidence withMDCT.The most common CT features we found is an oval lesion less than 5 cm that hasan attenuation equivalent to that of fat, that abuts the anterior colonic wall and that issurrounded by inflammatory changes. Thickening of the parietal peritoneum and of thecolonic wall also may be observed.Inflammation of epiplooic appendages in self-limited in the majority of patients, butrarely may result in adhesion, bowel obstruction, intussusception, peritonitis and abscessformation.On MDCT, PEA has a predictable appearance in terms of location, size and density. Highresolution MPR imaging helps improve diagnostic confidence (site and adverse features)compared with standard axial images.C.e. MDCT in an useful non-invasive method for differential diagnosis of acutePEA which helps avoiding unnecessary surgery in most patients . The appropriatemanagement of this condition is conservative, and the radiologist can provideguidance to supportive management.References1. CT Appearance of Acute Appendagitis. AK Singh, DA Gervais, PF Hahn etal. AJR November 2004 183:1303-1307.2. Epiploic Appendagitis: An Entity Frequently Unknown to Clinicians DiagnosticImaging, Pitfalls and Look- Alike. AT Almeida, L Melão, B Viamonte et al. AJR2009; 193:1243-1251.3. Clinical characteristics of primary epiploic appendagitis.YU Choi, PW Choi, YH ParkJ. Korean Soc Coloproctol 2011;27(3):114-1214. Acute Epiploic Appendagitis and Its Mimics. AK Singh, DA Gervais, PFHahn et al. RadioGraphics 2005; 25:1521-15. Beyond appendicitis: common and uncommon gastrointestinal causes ofright lower quadrant abdominal pain at multidetector CT.Andrei S. Purysko,MD Erick M. Remer, MD Hilton M. Leão Filho, MD Leonardo K. Bittencourt,Page 8 of 8MD Rodrigo V. Lima, MD Douglas J. Racy, MD. Radiographics 2011;31:927-947.6. Epiploic Appendagitis. VL Goh, CD Rudolph. Journal of PediatricsGastroenterology and nutrition 53(1):1, July 2011Personal Information

Role of MSCT scan in management of patients with primary
epiploic appendagitis; our experience

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Role of MSCT scan in management of patients with primary epiploic appendagitis; our experience

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