Objectives

1.To review the clinical presentations and pathophysiology of IFFI

2. To demonstrate the Ultrasound(U/S) and Computed Tomography (CT) features of IFFI

Background

The term IFFI refers to various self-limiting clinical conditions that are caused by focal fatty tissue necrosis. Most of the cases concern torsion or infarction of the greater omentum or the epiploic appendages and rarely the perigastric ligaments. All the above clinical conditions share common risk factors which involve obesity, recent abdominal surgery and trauma. Furthermore, they can frequently mimic other more concerning clinical conditions, such as acute appendicitis or diverticulitis, making the diagnosis a challenge from the clinician’s point of view in the acute phase.U/S and CT demonstrate a high sensitivity and specificity for the diagnosis of IFFI, thus preventing unnecessary surgical intervention.

Imaging findings OR Procedure findings

Only differing by their various anatomical locations, all cases of IFFI present with rather similar imaging features.We report cases of epiploic appendagitis in an acute, subacute and chronic phase in order to present the self-limiting nature of this entity. We also present cases of perigastric appendagitis and omental infarction along with cases with the “whirl sign’’which indicate torsion. Typical U/S imaging findings include a rounded non-compressible echogenic area at the site of maximal tenderness. CT usually reveals areas of increased fat attenuation with surrounding inflammatory changes and can also reveal possible complications.

Conclusion

An early and accurate diagnosis of IFFI is essential in order to provide correct patient treatment, thus avoiding unnecessary surgery. CT is the modality of choice for proper patient management and follow-up.