Evaulation with the primary epiploic appendagitis multidetector tomography

Aim: The purpose our study was to evaulate radiological findings of subjects with Primary epiploic appendigitis on MDCT and compare those findings with existing literature. Materials and Methods: We retrospectively reviewed findings of forty-nine consecutive cases who referred to Dicle University Department of Radiology between March 2009 and April 2014 with acute abdominal pain and had a confirmed diagnosis of PEA. All patients underwent contrast enhanced abdominal CT using either one of Philips Brilliance 64 detectors or Toshiba Activion 16 detectors row CT scanners. Results: In total, 32(65%) maleand 17 female (35%) patients diagnosed with PEA with an agerange of 18-82 (Mean age:36). Interms of decades, male patients were in a range of second to sixth decades, whereas femal eindividuals were in between four than nineth decades. On CT imaging, them ost significant finding of PEA was a fat density oval lesion smaller than five cm in the vicinity of the colonic wall. All cases showed a surrounding peripheral high density rim, which resulted from thickened visseral peritoneum. A central linear or punctate highdensity(centralfocussign), a finding that reflects a thrombosed vessel or hem orrhagic changes, was evident in 22(45%) individiuals. Longaxis of PEA diameter was smaller than five (range: 0.7 to 4.3 cm) cm in all cases. Location of PEA with respect to large bowel was adjacent to the sigmoid colon in 51%, descending colon in 33%, cecum in 6% , transversecolon in 6% and ascendingcolon in 4% of all cases. In 76% cases PEA was located anterior to the colonic lümen, in 18% lateral to the colonic lümen, in 4% inferior to the colonic lümen and in 2% medial to the colonic lumen. 22% of cases showed adjacent mesenteric stranding and 16% showed colonic wall thickening. Conclusion: PEA is an important non-surgical cause of acute abdominal pain and therefore it is important to distungiush this entity from its surgical counter parts. The CT imaging findings such as dimensions, localization and high-density peripheral rim may help to differentiate PEA from other fat related lesions and thus obviate the un necesseary hospitalizations, antibitherapy and surgical interventions, making it an important diagnosis to be born in mind. Keywords: Acute abdominal pain, multidetector computed tomography, primary epiplopic appandigitis