First AD

Second AD

A 45-year-old male patient presented with pain in the right iliac fossa.


Contrast axial CT scan at the level of the lower abdomen shows a fat-density ovoid structure adjacent to ascending colon, with a thin high-density rim, surrounding inflammatory fat stranding, with a central hyperdensity (black arrow in Figure 2).


Acute epiploic appendagitis is a self-limited inflammation of the appendices epiploicae. Epiploic appendages are peritoneal pouches arising from the serosal surface of the colon and are attached by a vascular stalk. The largest ones are located near the sigmoid colon and hence rectosigmoid junction is the most common site for acute epiploic appendagitis.

• Presents as acute right iliac fossa pain

• Torsion of epiploic appendages, with resultant ischemia has been implicated as the cause of acute epiploic appendagitis

• Prior to advent of CT, most cases were diagnosed at surgery 

• Oval non-compressible hyperechoic mass at the site of maximum tenderness, adjacent to the colon, with no central blood flow on color Doppler US images.

• Oval lesion less than 5 cm in diameter with fatty attenuation abutting the anterior colonic wall with surrounding inflammatory changes

• Central area of high attenuation due to venous thrombosis can be seen.

: Solitary large nonenhancing omental mass with heterogeneous attenuation, which lacks the hyperattenuating ring that is seen in epiploic appendagitis

 Colonic diverticula with inflammation or abscess in the mesocolon and with adjacent colonic wall thickening

Well-defined soft-tissue mass containing areas of fat attenuation to an ill-defined area of higher attenuation in the root of the small-bowel mesentery


Treated conservatively with oral anti-inflammatory medication, and antibiotics are not routinely indicated.


1. Singh A, Gervais D, Hahn P, Sagar P, Mueller P, Novelline R. Acute Epiploic Appendagitis and Its Mimics. 

2. Gaillard F. Epiploic appendagitis. Radiopaedia.org. 2016 [cited 15 December 2016]. Available from: https://radiopaedia.org/articles/epiploic-appendagitis.

Image IQ: 45 y/o, Pain in Right Iliac Fossa

Amar Udare, MBBS, MD