Abdominal ultrasonography
Abdominal imaging
Case TypeClinical Cases
AuthorsA. Hollerweger, P. Macheiner
Patient35 years, male
Patients usually present with acute or subacute abdominal pain and localised tenderness; laboratory parameters are within the normal range or show slight elevation of white blood cell count or sedimentation rate. Vomiting and nausea are rare (1,2).
Sonography typically shows an ovoid, non-compressible, moderately hyperechoic mass at the point of maximum tenderness (1,2,4,5). The mass may be surrounded by a hypoechoic rim and is frequently adherent to the parietal peritoneum of the abdominal wall. On colour Doppler sonography vascularisation is not visible in the infarcted omentum, but adjacent tissue shows moderately increased colour flow due to the inflammatory reaction.
CT scans show a corresponding fatty lesion with hyperattenuating streaks (1,2,5). The parietal peritoneum is often thickened, whereas the bowel wall appears normal.
Follow-up examinations show a slow decrease in lesion size and disappearance of the lesion over a period of 1–2 months.
In cases of segmental omentum infarction, both sonography and CT show characteristic features that enable the correct diagnosis. Clinical symptoms gradually disappear when treated with analgesics and, with appropriate diagnosis, unnecessary surgery can be avoided.
[1]
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Eur Radiol. 1999;9(9):1886-92. (PMID: 10602970)
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3. Schlesinger AE, Dorfman SR, Braverman RM. Sonographic appearance of omental infarction in children.
Pediatr Radiol. 1999 Aug;29(8):598-601. (PMID: 10415186)
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Eur Radiol. 2001;11(10):1867-77. (PMID: 11702119)
[5]
5. Hollerweger A, Rettenbacher T, Macheiner P, Gritzmann N. Spontaneous fatty tissue necrosis of the omentum majus and epiploic appendices: clinical, ultrasonic and CT findings.
Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr. 1996 Dec;165(6):529-34. (PMID: 9026094)
URL: | https://eurorad.org/case/1507 |
DOI: | 10.1594/EURORAD/CASE.1507 |
ISSN: | 1563-4086 |