Epiploic Appendagitis

An axial CT image of a 43-year-old man with left lower quadrant pain shows an oval fatty mass (arrow) with surrounding fat stranding. There is fascial thickening (arrowheads).

Epiploic Appendagitis

• Torsion of epiploic appendages results in vascular occlusion, leading to ischemia
• Inflammation of appendages is self limited. Rarely, it may result in adhesion, bowel obstruction, peritonitis, or abscess
  
• Common in 4th to 5th decades of life
• Acute pain, most in left lower quadrant - easily mistaken for acute diverticulitis
  

CT Appearance

• Anterior to colonic lumen, sigmoid colon > descending colon > cecum
  
• Oval fatty mass surrounded by inflammation, 1.5cm and 3.5cm size
  
• Central high-density focus represents venous thrombosis
  
• Colonic wall thickening rare
  

Reference:
Singh AK. CT appearance of acute appendagitis. AJR Am J Roentgenol 2004;183:1303-1307.