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1、EpiploicAppendagitisvsDiverticulitis:MakingtheRadiologicDistinctionMattBaker,MSIIIGillianLieberman,MDNovember16,2009Agenda•CasePresentation•Diverticulitis–Anatomy•DifferentialDiagnosis–Epidemiology•EpiploicAppendagitis–Pathophysiology–Anatomy–Clinicalpresentation–Epidemiology
2、–Radiologicappearance–Pathophysiology–Treatment–Clinicalpresentation•Differentiatingthe–RadiologicappearanceTwo–Treatment•TheImportance•CaseResolutionOurPatientMs.J:ClinicalPresentation•39yearoldwoman•h/odiverticulitis•LLQabdominalpainfor24hours•Painissharp,9/10,persistent,no
3、n‐radiating•DeniesanyN/V,diarrhea,constipation,F/C•Onexam:afebrileandexquisitelytenderintheLLQ,withsomeguardingtolightpalpation;norebound•WBC:6.9w/normaldifferentialDifferentialDiagnosisforaFemalePatientwithLLQPain•Diverticulitis•Ischemiccolitis•Bowelobstruction•Regionalenter
4、itis•Ureteralcolic•Torsion/ruptureofanovariancystortumor•Ectopicpregnancy•PIDACTwasobtainedtohelpnarrowthedifferential…OurPatientMs.J:AbdominalCTReport•IMPRESSION:–Stomach,duodenum,andsmallbowelnormalcaliber–Celiac,SMA,andIMAarepatent–Pelvicorgansunremarkable–Well‐definedfocu
5、soffatwithintheLLQdemonstratessurroundingfatstranding•Inflammationisadjacenttothesigmoidcolonwithdiverticula•Noinflameddiverticulaareidentified•Colonisnon‐distended•Nofreeair•Smallamountoffluidinthecul‐de‐sacislikelyphysiologic•Finalread:Epiploicappendagitisversusdiverticulit
6、isBeforeinterpretingMs.J’sabdominalCT,let’slearnaboutepiploicappendagitisanddiverticulitis,andhowtheyarediagnosedradiologically…Anatomy:EpiploicAppendages•Visceralperitonealoutpouchingscontainingfatandbloodvessels•Locatedontheserosalsurfaceofthecolon•Mostcommoninsigmoidcolona
7、ndAcross‐sectionaldiagramofthecolon,showingtherelationshipbetweenepiploicappendices(A),cecumcolicartery(B),straightartery(C),mesocolon(D).•Usually1‐2cmthickSource:http://www.eurorad.org/case.php?id=1113and2‐5cmlongEpiploicAppendagesonPathologyPathologicspecimenSource:http://e
8、ct.downstate.edu/courseware/haonline/imgs/00000/8000/700/8736.jpgNor
