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Zorluk: OrtaInterpreting Imaging Results

A 34-year-old man presents to the emergency department with a 2-day history of sharp, constant right lower quadrant abdominal pain. He reports no nausea, vomiting, or changes in bowel habits. His temperature is 37.2°C (99.0°F), blood pressure is 128/78 mmHg, and pulse is 82/min. Physical examination reveals localized tenderness to palpation in the right lower quadrant without rebound or guarding. Laboratory studies show a leukocyte count of 11,500/mm³. A contrast-enhanced computed tomography (CT) scan of the abdomen and pelvis is performed. The scan reveals a 2.5-cm, oval-shaped, fat-density lesion located anterior to the ascending colon, featuring a hyperdense rim and a central high-attenuation dot. There is mild surrounding inflammatory fat stranding. The colonic wall demonstrates normal thickness, and the appendix measures 5 mm in diameter with no surrounding fluid. Based on these imaging findings, which of the following is the most likely diagnosis?

  1. Epiploic appendagitisCevap
  2. B
    Acute appendicitis
  3. C
    Right-sided acute diverticulitis
  4. D
    Omental infarction
  5. E
    Mesenteric lymphadenitis

Cevap

Epiploic appendagitis is the most likely diagnosis, characterized on CT by a fat-density lesion with a hyperdense rim and central dot.
The diagnosis is epiploic appendagitis, a benign, self-limiting condition caused by torsion or venous thrombosis of an epiploic appendage. It classically presents with focal abdominal pain mimicking appendicitis or diverticulitis. The pathognomonic CT finding is a 1- to 4-cm oval, fat-density lesion adjacent to the colon wall with surrounding inflammatory stranding. The hyperdense ring corresponds to the inflamed visceral peritoneum covering the appendage, and the 'central dot sign' represents the central thrombosed draining vein.

Adım Adım Çözüm

1
Analyze the patient's clinical presentation.
The patient has localized right lower quadrant pain and mild leukocytosis without significant systemic symptoms (e.g., normal temperature, no nausea/vomiting).
This presentation narrows the differential diagnosis to right-sided abdominal pathologies such as acute appendicitis, diverticulitis, epiploic appendagitis, and omental infarction.
2
Interpret the specific findings on the contrast-enhanced CT scan.
The CT shows a 2.5-cm, oval-shaped, fat-density lesion with a hyperdense rim and central high-attenuation dot adjacent to a normal-appearing colon. The appendix is explicitly normal.
Accurate interpretation of the imaging is required to establish the correct diagnosis and avoid unnecessary surgery or antibiotics.
3
Correlate the pathognomonic imaging sign with the correct condition.
The 'central dot sign' within a fat-density oval lesion represents a thrombosed venous appendage, which is the hallmark of epiploic appendagitis.
Identifying this specific radiographic sign reliably differentiates epiploic appendagitis from other surgical and medical causes of right lower quadrant pain.

Anahtar Kavram

Epiploic appendagitis is characterized on computed tomography by an oval, fat-density lesion adjacent to the colon, frequently displaying a hyperdense rim and a central high-attenuation dot (the central dot sign).
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Interpreting Imaging Results

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