Images

Doctor's Information

Name : Seyed Amir Hossien
Family : Jafarisepehr
Affiliation :Radiology department of sina hospital
Academic Degree : Assistant professor
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : Reza Hanifehpour

Case Section

Abdominal Imaging

Patient's Information

Gender : Male
Age : 37

Clinical Summary

A 37Y/O man with RUQ pain

Imaging Findings

Axial contrast-enhanced CT image shows localized soft-tissue infiltration in anteromedial to the ascending colon , which represents a subtle example of right-sided omental infarction. No evidence of fluid in abdomen is detected. A simple cyst measuring 43*38mm in left kidney  is also seen.

Differential Diagnosis

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Final Diagnosis

omental infarction

Discussion (Related Text)

The greater omentum, composed of a double layer of peritoneum, hangs from the greater curvature of the stomach and the proximal part of the duodenum, covering the small bowel. On CT it appears as a band of fatty tissue of variable thickness, just beneath the anterior abdominal wall and anterior to the stomach, transverse colon, and small bowel. Multiple small omental vessels are usually visible. Similar to epiploic appendagitis, torsion of the omentum or venous thrombosis of the omental vessels may lead to omental infarction, which usually occurs in the right lower or right upper quadrant, clinically mimicking appendicitis or cholecystitis. This bias for the right side of the abdomen is theorized to be related to variant embryologic vascular development, predisposing to right-sided venous thrombosis. Other contributing factors include obesity, strenuous activity, congestive heart failure, digitalis administration, recent abdominal surgery, and abdominal trauma. Although most cases occur in adults, approximately 15% of cases affect the pediatric population. CT findings of omental infarct may vary from hazy soft tissue infiltration to a large heterogeneous mass. Most commonly, the inflammatory mass is in the right lower quadrant, anteromedial to the ascending colon or anterior to the transverse colon. Although omental infarction may be difficult to distinguish from epiploic appendagitis, the inflammatory mass associated with omental infarction is typically larger. Like epiploic appendagitis, however, the condition is self-limited and the treatment conservative.

References

John R. Haaga, MD CT and MRI of the Whole Body, 5th edition .P 1757

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