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Intra-abdominal fat. Part II: Non-cancerous lesions of the adipose tissue localized beyond organs.

Smereczyński A, Kołaczyk K, Bernatowicz E - J Ultrason (2016)

Bottom Line: The value of ultrasonography in the diagnosis of this pathology is underestimated, and a number of US scan reports do not reflect its presence in any way.This section focuses on infarction of the greater and lesser omentum, epiploic appendagitis, mesenteric volvulus and focal fat necrosis resulting from pancreatitis.Abstract available from the publisher.

View Article: PubMed Central - PubMed

Affiliation: Self-Education Ultrasound Study Group, Department of Genetics and Pathomorphology of the Pomeranian Medical University in Szczecin, Poland.

ABSTRACT
Adipose tissue does not belong to the most favorite structures to be visualized by ultrasound. It is not, however, free from various pathologies. The aim of this paper is to make abdominal cavity examiners more familiar with non-cancerous lesions found in intra-abdominal fat. The main focus is lesions that are rarely discussed in the literature. Visceral adiposity is one of important pathogenetic factors contributing to cardiovascular events, metabolic syndrome and even certain neoplasms. That is why this article exposes sonographic features that are the most characteristic of these lesions. The value of ultrasonography in the diagnosis of this pathology is underestimated, and a number of US scan reports do not reflect its presence in any way. Moreover, the article discusses more and more common mesenteritis, the lack of knowledge of which could pose difficulties in explaining the nature of symptoms reported by patients. Furthermore, this review presents lesions referred to in the literature as focal infarction of intra-abdominal fat. This section focuses on infarction of the greater and lesser omentum, epiploic appendagitis, mesenteric volvulus and focal fat necrosis resulting from pancreatitis. These lesions should be assessed with respect to the clinical context, and appropriate techniques of ultrasonography should be employed to allow careful determination of the size, shape, acoustic nature and location of lesions in relation to the integuments and large bowel, as well as their reaction to compression with an ultrasound transducer and behavior during deep inspiration. Moreover, each lesion must be obligatorily assessed in terms of blood flow. Doppler evaluation enables the differentiation between primary and secondary inflammation of intra-abdominal fat. The paper also draws attention to a frequent indirect sign of a pathological process, i.e. thickening and hyperechogenicity of fat, which sometimes indicates an ongoing pathology at a deeper site. This structure may completely conceal the primary lesion rendering it inaccessible for ultrasound. In such cases and in the event of other doubts, computed tomography should be the next diagnostic step.

No MeSH data available.


Related in: MedlinePlus

Secondary epiploic appendagitis (arrows) as a reaction in typhlitis
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Figure 0007: Secondary epiploic appendagitis (arrows) as a reaction in typhlitis

Mentions: Epiploic appendagitis (torsion) accounts for 1.3% of patients presenting with abdominal pain and constitutes 8.8 cases per million a year in the general population(31). These lesions are particularly common in the descending and sigmoid colon. That is why they can clinically resemble colonic diverticulitis. The former pathology is much more difficult to distinguish in ultrasound. Despite its superficial location under the abdominal wall, it does not distinguish itself clearly from adjacent tissues. An indicating sign is localized pain reported by patients or evoked with the use of a transducer. At this site, one can see a slightly hyperechoic structure, usually of ovoid shape and sometimes surrounded with a halo. It does not present vascularity or undergo deformation upon compression (Fig. 6 A, B). In some cases, a central hypoechoic area with a blurred outline can be spotted. Such a lesion sometimes adheres to the parietal peritoneum during deep inspiration. It usually slightly deviates externally and lies on the intestinal wall that is not thickened(24, 25, 32, 33). Elastography and contrast-enhanced ultrasound can be helpful in the diagnosis(33, 34). Lesions located deeper in the pelvis minor are usually imaged by transrectal ultrasound(35). There are cases in which omental infarction is indistinguishable from twisted epiploic appendage in US imaging. That is why van Breda Vriesman et al.(36) have proposed that such lesions be referred to as intra-abdominal focal fat infarction (IFFI). In all IFFI cases, it should be verified that the lesion is not a secondary fat pad as a reaction to inflammation, e.g. appendicitis or diverticulitis. This is indicated by blood flow within this structure seen in a color Doppler examination (Fig. 7)(32, 33). Moreover, primary epiploic appendagitis may mimic peritoneal implants of cancers, particularly ovarian carcinoma(37) (Fig. 8). Finally, it must be added that exceptional cases include torsion of the epiploic appendage of the hepatic ligamentum teres(24) or its detachment as a loose body into the peritoneum(38).


Intra-abdominal fat. Part II: Non-cancerous lesions of the adipose tissue localized beyond organs.

Smereczyński A, Kołaczyk K, Bernatowicz E - J Ultrason (2016)

Secondary epiploic appendagitis (arrows) as a reaction in typhlitis
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4834369&req=5

Figure 0007: Secondary epiploic appendagitis (arrows) as a reaction in typhlitis
Mentions: Epiploic appendagitis (torsion) accounts for 1.3% of patients presenting with abdominal pain and constitutes 8.8 cases per million a year in the general population(31). These lesions are particularly common in the descending and sigmoid colon. That is why they can clinically resemble colonic diverticulitis. The former pathology is much more difficult to distinguish in ultrasound. Despite its superficial location under the abdominal wall, it does not distinguish itself clearly from adjacent tissues. An indicating sign is localized pain reported by patients or evoked with the use of a transducer. At this site, one can see a slightly hyperechoic structure, usually of ovoid shape and sometimes surrounded with a halo. It does not present vascularity or undergo deformation upon compression (Fig. 6 A, B). In some cases, a central hypoechoic area with a blurred outline can be spotted. Such a lesion sometimes adheres to the parietal peritoneum during deep inspiration. It usually slightly deviates externally and lies on the intestinal wall that is not thickened(24, 25, 32, 33). Elastography and contrast-enhanced ultrasound can be helpful in the diagnosis(33, 34). Lesions located deeper in the pelvis minor are usually imaged by transrectal ultrasound(35). There are cases in which omental infarction is indistinguishable from twisted epiploic appendage in US imaging. That is why van Breda Vriesman et al.(36) have proposed that such lesions be referred to as intra-abdominal focal fat infarction (IFFI). In all IFFI cases, it should be verified that the lesion is not a secondary fat pad as a reaction to inflammation, e.g. appendicitis or diverticulitis. This is indicated by blood flow within this structure seen in a color Doppler examination (Fig. 7)(32, 33). Moreover, primary epiploic appendagitis may mimic peritoneal implants of cancers, particularly ovarian carcinoma(37) (Fig. 8). Finally, it must be added that exceptional cases include torsion of the epiploic appendage of the hepatic ligamentum teres(24) or its detachment as a loose body into the peritoneum(38).

Bottom Line: The value of ultrasonography in the diagnosis of this pathology is underestimated, and a number of US scan reports do not reflect its presence in any way.This section focuses on infarction of the greater and lesser omentum, epiploic appendagitis, mesenteric volvulus and focal fat necrosis resulting from pancreatitis.Abstract available from the publisher.

View Article: PubMed Central - PubMed

Affiliation: Self-Education Ultrasound Study Group, Department of Genetics and Pathomorphology of the Pomeranian Medical University in Szczecin, Poland.

ABSTRACT
Adipose tissue does not belong to the most favorite structures to be visualized by ultrasound. It is not, however, free from various pathologies. The aim of this paper is to make abdominal cavity examiners more familiar with non-cancerous lesions found in intra-abdominal fat. The main focus is lesions that are rarely discussed in the literature. Visceral adiposity is one of important pathogenetic factors contributing to cardiovascular events, metabolic syndrome and even certain neoplasms. That is why this article exposes sonographic features that are the most characteristic of these lesions. The value of ultrasonography in the diagnosis of this pathology is underestimated, and a number of US scan reports do not reflect its presence in any way. Moreover, the article discusses more and more common mesenteritis, the lack of knowledge of which could pose difficulties in explaining the nature of symptoms reported by patients. Furthermore, this review presents lesions referred to in the literature as focal infarction of intra-abdominal fat. This section focuses on infarction of the greater and lesser omentum, epiploic appendagitis, mesenteric volvulus and focal fat necrosis resulting from pancreatitis. These lesions should be assessed with respect to the clinical context, and appropriate techniques of ultrasonography should be employed to allow careful determination of the size, shape, acoustic nature and location of lesions in relation to the integuments and large bowel, as well as their reaction to compression with an ultrasound transducer and behavior during deep inspiration. Moreover, each lesion must be obligatorily assessed in terms of blood flow. Doppler evaluation enables the differentiation between primary and secondary inflammation of intra-abdominal fat. The paper also draws attention to a frequent indirect sign of a pathological process, i.e. thickening and hyperechogenicity of fat, which sometimes indicates an ongoing pathology at a deeper site. This structure may completely conceal the primary lesion rendering it inaccessible for ultrasound. In such cases and in the event of other doubts, computed tomography should be the next diagnostic step.

No MeSH data available.


Related in: MedlinePlus