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Epiploic Appendagitis
Michael P. Federle, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Abbreviations

                • Epiploic appendagitis (EA)
              • Definitions

                • Acute inflammation or infarction of epiploic appendages 
                • Primary EA: No other underlying inflammatory condition
                • Secondary EA: Appendages may be inflamed due to adjacent process, such as diverticulitis or abdominal abscess

              IMAGING

              • General Features

                • CT Findings

                  • MR Findings

                    • Ultrasonographic Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Gross Pathologic & Surgical Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Image Interpretation Pearls

                                            Selected References

                                            1. Menozzi G et al: Contrast-enhanced ultrasound appearance of primary epiploic appendagitis. J Ultrasound. 17(1):75-6, 2014
                                            2. Shields AM et al: A twist in the tale: epiploic appendagitis mimicking acute appendicitis. BMJ Case Rep. 2014, 2014
                                            3. Hwang JA et al: Differential diagnosis of left-sided abdominal pain: primary epiploic appendagitis vs colonic diverticulitis. World J Gastroenterol. 19(40):6842-8, 2013
                                            4. Lee CC et al: Clinical challenges and images in GI. Epiploic appendagitis. Gastroenterology. 134(7):1829, 2196, 2008
                                            5. Ng KS et al: CT features of primary epiploic appendagitis. Eur J Radiol. 2006
                                            6. Pereira JM et al: CT and MR imaging of extrahepatic fatty masses of the abdomen and pelvis: techniques, diagnosis, differential diagnosis, and pitfalls. Radiographics. 25(1):69-85, 2005
                                            7. Singh AK et al: Acute epiploic appendagitis and its mimics. Radiographics. 25(6):1521-34, 2005
                                            8. Sandrasegaran K et al: Primary epiploic appendagitis: CT diagnosis. Emerg Radiol. 11(1):9-14, 2004
                                            9. Singh AK et al: CT appearance of acute appendagitis. AJR Am J Roentgenol. 183(5):1303-7, 2004
                                            10. Chowbey PK et al: Torsion of appendices epiploicae presenting as acute abdomen: laparoscopic diagnosis and therapy. Indian J Gastroenterol. 22(2):68-9, 2003
                                            11. Ghosh BC et al: Primary epiploic appendagitis: diagnosis, management, and natural course of the disease. Mil Med. 168(4):346-7, 2003
                                            12. van Breda Vriesman AC: The hyperattenuating ring sign. Radiology. 226(2):556-7, 2003
                                            13. Chung SP et al: Primary epiploic appendagitis. Am J Emerg Med. 20(1):62, 2002
                                            14. Hollerweger A et al: Primary epiploic appendagitis: sonographic findings with CT correlation. J Clin Ultrasound. 30(8):481-95, 2002
                                            15. Legome EL et al: Epiploic appendagitis: the emergency department presentation. J Emerg Med. 22(1):9-13, 2002
                                            16. Sirvanci M et al: Primary epiploic appendagitis: MRI findings. Magn Reson Imaging. 20(1):137-9, 2002
                                            17. Son HJ et al: Clinical diagnosis of primary epiploic appendagitis: differentiation from acute diverticulitis. J Clin Gastroenterol. 34(4):435-8, 2002
                                            18. van Breda Vriesman AC et al: Epiploic appendagitis and omental infarction: pitfalls and look-alikes. Abdom Imaging. 27(1):20-8, 2002
                                            19. Horton KM et al: CT evaluation of the colon: inflammatory disease. Radiographics. 20(2):399-418, 2000
                                            20. Rao PM et al: Case 6: primary epiploic appendagitis. Radiology. 210(1):145-8, 1999
                                            21. Habib FA et al: Laparoscopic approach to the management of incarcerated hernia of appendices epiploicae: report of two cases and review of the literature. Surg Laparosc Endosc. 8(6):425-8, 1998
                                            22. Rao PM et al: Misdiagnosis of primary epiploic appendagitis. Am J Surg. 176(1):81-5, 1998
                                            23. Rao PM et al: Primary epiploic appendagitis: evolutionary changes in CT appearance. Radiology. 204(3):713-7, 1997
                                            24. Rioux M et al: Primary epiploic appendagitis: clinical, US, and CT findings in 14 cases. Radiology. 191(2):523-6, 1994
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Pathology

                                                    • Clinical Issues

                                                      • Diagnostic Checklist

                                                        TERMINOLOGY

                                                        • Abbreviations

                                                          • Epiploic appendagitis (EA)
                                                        • Definitions

                                                          • Acute inflammation or infarction of epiploic appendages 
                                                          • Primary EA: No other underlying inflammatory condition
                                                          • Secondary EA: Appendages may be inflamed due to adjacent process, such as diverticulitis or abdominal abscess

                                                        IMAGING

                                                        • General Features

                                                          • CT Findings

                                                            • MR Findings

                                                              • Ultrasonographic Findings

                                                                • Imaging Recommendations

                                                                  DIFFERENTIAL DIAGNOSIS

                                                                    PATHOLOGY

                                                                    • General Features

                                                                      • Gross Pathologic & Surgical Features

                                                                        • Microscopic Features

                                                                          CLINICAL ISSUES

                                                                          • Presentation

                                                                            • Demographics

                                                                              • Natural History & Prognosis

                                                                                • Treatment

                                                                                  DIAGNOSTIC CHECKLIST

                                                                                  • Consider

                                                                                    • Image Interpretation Pearls

                                                                                      Selected References

                                                                                      1. Menozzi G et al: Contrast-enhanced ultrasound appearance of primary epiploic appendagitis. J Ultrasound. 17(1):75-6, 2014
                                                                                      2. Shields AM et al: A twist in the tale: epiploic appendagitis mimicking acute appendicitis. BMJ Case Rep. 2014, 2014
                                                                                      3. Hwang JA et al: Differential diagnosis of left-sided abdominal pain: primary epiploic appendagitis vs colonic diverticulitis. World J Gastroenterol. 19(40):6842-8, 2013
                                                                                      4. Lee CC et al: Clinical challenges and images in GI. Epiploic appendagitis. Gastroenterology. 134(7):1829, 2196, 2008
                                                                                      5. Ng KS et al: CT features of primary epiploic appendagitis. Eur J Radiol. 2006
                                                                                      6. Pereira JM et al: CT and MR imaging of extrahepatic fatty masses of the abdomen and pelvis: techniques, diagnosis, differential diagnosis, and pitfalls. Radiographics. 25(1):69-85, 2005
                                                                                      7. Singh AK et al: Acute epiploic appendagitis and its mimics. Radiographics. 25(6):1521-34, 2005
                                                                                      8. Sandrasegaran K et al: Primary epiploic appendagitis: CT diagnosis. Emerg Radiol. 11(1):9-14, 2004
                                                                                      9. Singh AK et al: CT appearance of acute appendagitis. AJR Am J Roentgenol. 183(5):1303-7, 2004
                                                                                      10. Chowbey PK et al: Torsion of appendices epiploicae presenting as acute abdomen: laparoscopic diagnosis and therapy. Indian J Gastroenterol. 22(2):68-9, 2003
                                                                                      11. Ghosh BC et al: Primary epiploic appendagitis: diagnosis, management, and natural course of the disease. Mil Med. 168(4):346-7, 2003
                                                                                      12. van Breda Vriesman AC: The hyperattenuating ring sign. Radiology. 226(2):556-7, 2003
                                                                                      13. Chung SP et al: Primary epiploic appendagitis. Am J Emerg Med. 20(1):62, 2002
                                                                                      14. Hollerweger A et al: Primary epiploic appendagitis: sonographic findings with CT correlation. J Clin Ultrasound. 30(8):481-95, 2002
                                                                                      15. Legome EL et al: Epiploic appendagitis: the emergency department presentation. J Emerg Med. 22(1):9-13, 2002
                                                                                      16. Sirvanci M et al: Primary epiploic appendagitis: MRI findings. Magn Reson Imaging. 20(1):137-9, 2002
                                                                                      17. Son HJ et al: Clinical diagnosis of primary epiploic appendagitis: differentiation from acute diverticulitis. J Clin Gastroenterol. 34(4):435-8, 2002
                                                                                      18. van Breda Vriesman AC et al: Epiploic appendagitis and omental infarction: pitfalls and look-alikes. Abdom Imaging. 27(1):20-8, 2002
                                                                                      19. Horton KM et al: CT evaluation of the colon: inflammatory disease. Radiographics. 20(2):399-418, 2000
                                                                                      20. Rao PM et al: Case 6: primary epiploic appendagitis. Radiology. 210(1):145-8, 1999
                                                                                      21. Habib FA et al: Laparoscopic approach to the management of incarcerated hernia of appendices epiploicae: report of two cases and review of the literature. Surg Laparosc Endosc. 8(6):425-8, 1998
                                                                                      22. Rao PM et al: Misdiagnosis of primary epiploic appendagitis. Am J Surg. 176(1):81-5, 1998
                                                                                      23. Rao PM et al: Primary epiploic appendagitis: evolutionary changes in CT appearance. Radiology. 204(3):713-7, 1997
                                                                                      24. Rioux M et al: Primary epiploic appendagitis: clinical, US, and CT findings in 14 cases. Radiology. 191(2):523-6, 1994