Primary Epiploic Appendagitis of the Appendix Vermiformis.

INTRODUCTION: Primary epiploic appendagitis, a relatively rare and self-limiting disease, often clinically mimics conditions of the acute abdomen such as acute appendicitis and acute diverticulitis. It is important to make accurate diagnoses because its treatment is conservative. Ultrasonography and computed tomographic studies enable a reliable diagnosis to prevent unnecessary invasive procedures. Herein, we report a case of primary epiploic appendagitis of the appendix vermiformis with clinical, laboratory and CT findings to improve awareness of this condition. CASE PRESENTATION: A 29-year-old female presented with acute abdominal pain in the right lower quadrant. Her medical history was not significant for surgery. She had no nausea, vomiting, diarrhea or fever. On physical examination, she had right lower quadrant tenderness with mild defense and rebound upon palpation. The leukocyte count (6300 mm-3) and other laboratory parameters, including urine tests, were unremarkable. With these findings, the provisional diagnosis of acute appendicitis was made, and a CT examination (Mx 8000 IDT 16, Philips, USA) was done upon the request of the referring physicians. The abdominal CT showed normal appendix vermiformis. However, a fat density lesion surrounding a hyperdense rim was seen adjacent to the appendix vermiformis. The diagnosis of PEA was thus established based on the characteristic radiologic findings. The patient was managed conservative treatment with pain medication as an outpatient. After a one-week follow-up, the patient was observed to be symptom-free and concluded to have recovered fully from their physician. CONCLUSION: To conclude, PEA needs to be considered by emergency clinicians and radiologists in the differential diagnosis of acute abdominal pain. With this in mind, it becomes easier for a substantive diagnosis to be made by ultrasound alone or combined with CT to prevent unnecessary surgical interventions, antibiotherapy and hospitalization.

Apparent diffusion coefficient in differentiation of pediatric posterior fossa tumors.

PURPOSE: To investigate the contribution of preoperative apparent diffusion coefficient (ADC) values in the differential diagnosis of pediatric posterior fossa tumors. METHODS: Forty-two pediatric patients (mean age 7.76 ± 4.58 years) with intra-axial tumors in the infra-tentorial region underwent magnetic resonance imaging. ADC measurement was performed using regions of interest, obtained from the solid component of the mass lesions. ADC ratios were calculated by dividing the ADC values from the mass lesions by the ADC values from normal cerebellar parenchyma. Lesions were categorized as juvenile pilocytic astrocytoma (JPA), ependymoma and medulloblastoma based on histopathological diagnosis. ADC values of the lesions and histopathological diagnoses were statistically correlated. RESULTS: Histopathological diagnosis showed that 14 lesions were JPA, 10 were ependymoma; 18 were medulloblastoma. Both ADC values and ADC ratios were significantly correlated with tumor types (p <0.05). Astrocytoma was distinguished from ependymoma with sensitivity 85.7% and specificity 90% using an ADC ratio ≥1.7 and medulloblastoma was distinguished from ependymoma with sensitivity 100% and specificity 88.89% using an ADC ratio ≤1.18. CONCLUSION: Preoperative ADC values could differentiate the main histological subtypes of pediatric posterior fossa tumors with high sensitivity and specificity.