Mesenteric panniculitis: US and CT features.

Mesenteric panniculitis is an aseptic inflammation of mesenteric fat. Before the age of ultrasonography (US) and computed tomography (CT), mesenteric panniculitis was rarely diagnosed, but today the disorder is more commonly encountered, often as an incidental imaging finding. Its exact cause remains unknown. This review illustrates the characteristic US and CT features of mesenteric panniculitis and discusses its differential diagnosis.

[Diagnostic image (186) A man with abdominal pain in the left upper quadrant. Acute appendicitis with malrotation of the colon]. / Diagnose in beeld (186). Een man met pijn linksboven in de buik. Linkszijdige appendicitis acuta met malrotatie van het colon.

A 54-year-old man presented with abdominal pain in the left upper quadrant due to acute appendicitis with a malrotation of the colon.

Effect of ultrasonography and optional computed tomography on the outcome of appendectomy.

The aim of this study was to investigate the value of US and complementary CT in patients with suspected appendicitis, and to detect adverse outcomes of preoperative imaging. We retrospectively reviewed the data of 233 consecutive patients who underwent an appendectomy as an emergency procedure in our hospital, within a 2-year period. Our hospital policy is to perform diagnostic imaging in all patients with clinical suspicion of appendicitis. The US was performed in 227 patients, followed by additional unenhanced helical focused appendiceal CT in 30 patients with equivocal US results. We evaluated the negative appendectomy rate, occurrence of perforation, and our in-hospital delay. Acute appendicitis was pathologically proven in 219 patients, corresponding to a negative appendectomy rate of 6%. The US with optional CT diagnosed appendicitis with a sensitivity of 96.7%. Forty-eight appendices (21.9%) were perforated. The median overall in-hospital delay was 5 h (range 0.5-123.5 h). For the perforated appendices this was 4.5 h (range 0.5-64.5 h), for the non-perforated appendices 6.0 h (range 0.5-123.5 h). In patients with suspected acute appendicitis, US examination with the option of additional CT significantly lowers the negative appendectomy rate as compared with the clinical acumen alone, without adverse effects on the perforation rate or the in-hospital delay.

[Epiploic appendagitis: an underestimated self-limiting acute abdominal condition]. / Appendagitis epiploica: een onderbelichte zelflimiterende acute buikaandoening.

OBJECTIVE: To describe the clinical findings in patients with epiploic appendagitis and to evaluate its natural course. DESIGN: Retrospective. METHOD: A review of the medical records was carried out for all patients who were diagnosed with epiploic appendagitis using ultrasonography and computed tomography (CT), during the period June 1988-October 2001, at the Haaglanden Medical Centre (Westeinde site), The Hague, the Netherlands. RESULTS: The study group consisted of 49 patients, 38 men and 11 women, with a median age of 41 years. The main symptom was focal abdominal pain, with a median diagnostic delay in the patients of 2 days, located in the left lower quadrant (n = 34), right lower quadrant (n = 8), right upper quadrant (n = 6) or left upper quadrant (n = 1) of the abdomen. No other complaints were present with the exception of nausea and vomiting in two patients. Leucocytosis was found in 21% of patients, the erythrocyte sedimentation rate was elevated in 26% of the patients, and signs of peritoneal irritation were found in 53% of the patients. Epiploic appendagitis was correctly included in the clinical differential diagnosis of 2 patients. All of the patients made a complete and uncomplicated recovery under conservative treatment; the majority were symptom-free within 9 days. CONCLUSION: Due to the increased use of diagnostic imaging in patients with acute abdominal symptoms, epiploic appendagitis is much more frequently diagnosed than before. Presenting symptoms of epiploic appendagitis are non-specific, leading to misdiagnosis in most cases. Epiploic appendagitis has a benign natural course and if patients are correctly diagnosed using ultrasonography and CT, unnecessary surgery and medical treatment may be avoided.

Epiploic appendagitis and omental infarction: pitfalls and look-alikes.

Epiploic appendagitis and omental infarction are benign self-limiting conditions that are more frequent than generally assumed. Both disorders frequently mimic symptoms of an abdominal surgical emergency, often leading to clinical misdiagnosis of appendicitis or diverticulitis. Because a misdiagnosis can result in an unnecessary laparotomy, a correct diagnosis is of great importance. Ultrasound and computed tomography can be used to make a reliable diagnosis. This pictorial essay illustrates the various ultrasonographic and computed tomographic appearances of epiploic appendagitis and omental infarction and focuses on their radiologic differential diagnoses and pitfalls.

Epiploic appendagitis and omental infarction.

Epiploic appendagitis and omental infarction are benign self-limiting disorders. They are uncommon, though more common than is generally assumed. In both diseases the main clinical symptom is non-specific focal abdominal pain, with a normal or moderately raised white blood cell count and erythrocyte sedimentation rate. These findings often mimic an abdominal surgical emergency, which leads to clinical misdiagnosis of more common conditions such as appendicitis or diverticulitis. This may result in an unnecessary laparotomy. Ultrasonography (US) and computed tomography (CT) show characteristic features in most patients, allowing a secure non-operative diagnosis. Patients correctly diagnosed can avoid an operation or costly observation in hospital.

[Enterovesical fistula in diverticulitis]. / Enterovesicale fistel bij diverticulitis.

Three men aged 52, 60, and 38 years, complained of dysuria and recurrent cystitis. One patient mentioned pneumaturia, a feature which later appeared to be present in all three. Ultrasound examination showed air in the bladder, and demonstrated the fistulous tract in two cases. Computed tomography identified the third fistula. In all 3 the enterovesical fistula was a complication of sigmoid diverticulitis. After sigmoid resection they recovered well. The key to the diagnosis of enterovesical fistula is to think of it. Pneumaturia and faecaluria are pathognomonic symptoms. Both ultrasound and computed tomography may be helpful in the diagnosis.

Infarction of omentum and epiploic appendage: diagnosis, epidemiology and natural history.

Epiploic appendicitis and segmental omentum infarction are considered to be rare conditions, which may mimic an abdominal surgical emergency. The purpose of our study was to describe clinical findings, US and CT appearance of infarction of an epiploic appendage and omentum, and to determine their epidemiological characteristics and natural history. We retrospectively studied clinical, US and CT findings at hospital admission and follow-up of all patients who were diagnosed at our institution with epiploic appendicitis or omentum infarction between June 1988 and November 1997. We found a relatively high incidence of 40 cases: 20 patients with epiploic appendicitis, 11 with omentum infarction, and 9 in whom it was not possible to discriminate between the both. All 40 patients recovered under conservative treatment without complications. We conclude that US and CT features allow a reliable diagnosis, thereby obviating unnecessary surgery. Discriminating between both conditions is of no practical relevance since treatment and prognosis are identical.

Old and new infarction of an epiploic appendage: ultrasound mimicry of appendicitis.

Epiploic appendagitis is a self-limiting disease. Depending on its location, it may simulate nearly any acute abdominal condition. The ultrasound and computed tomographic (CT) features are characteristic, enabling ready diagnosis and thus preventing an unnecessary laparotomy. We describe a patient with acute abdominal pain in the right lower quadrant, in whom the combination of an old and fresh infarction of an epiploic appendage simulated appendicitis on ultrasound. Subsequent CT examination made the correct diagnosis.