C/o right side stomach pain with appendicitis on usg
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omental fat stranding right lower quadrant CT differential diagnosis
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Now I have enough information to provide a comprehensive clinical interpretation. Let me synthesize the findings.
CECT Abdomen & Pelvis — Clinical Interpretation
Patient: Ms. Swetapadma Rout | 26F | Right-sided abdominal pain | USG suggested appendicitis
Key CECT Findings
| Finding | Significance |
|---|---|
| Appendix — normal size, air in lumen, no wall thickening | Rules out appendicitis on CT |
| Subtle omental fat stranding in right lower abdomen | Active inflammatory/ischaemic process in periappendiceal fat |
| Corpus luteum in right ovary | Gynaecological cause of pain |
| Minimal free fluid in POD | Physiological (corpus luteum) or mild peritoneal irritation |
Radiologist's Impression: ? Omental Panniculitis (Epiploic Appendagitis / Focal Fat Stranding)
The CECT shows isolated fat stranding without an inflamed appendix — this is a distinct entity from appendicitis.
Most Likely Diagnoses (Differential):
-
Epiploic appendagitis — focal ischaemia/torsion of an omental/epiploic appendage; causes right lower quadrant pain that mimics appendicitis clinically. Self-limiting; managed conservatively with NSAIDs. CT is diagnostic (fat density lesion ± central dot sign).
-
Focal omental infarction / omental panniculitis — inflammatory change in the greater omentum without an underlying bowel or appendix cause. Also self-limiting.
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Corpus luteum cyst pain — the noted right ovarian corpus luteum can cause right-sided pain, especially mid-cycle or luteal phase. The small amount of free fluid in the Pouch of Douglas (POD) supports a recent ovulation/luteal event.
-
Appendicitis— effectively excluded by CT (normal appendix, air in lumen, no periappendiceal oedema/wall thickening).
Why USG Said "Appendicitis" but CT Disagrees
Ultrasound has ~78–86% sensitivity for appendicitis but is operator-dependent and body-habitus dependent. A non-visualised appendix on USG in the setting of right iliac fossa (RIF) pain is often reported as "appendicitis cannot be excluded." CECT is the gold standard — a normal appendix with air on CT has ~98% negative predictive value for appendicitis (Sabiston Textbook of Surgery; Mulholland & Greenfield's Surgery).
Recommended Management
- No surgical intervention needed — appendix is normal on CT
- NSAIDs (e.g. ibuprofen/diclofenac) for 1–2 weeks — first-line for epiploic appendagitis/omental panniculitis
- Gynaecology review if pain is cyclical or worsens — corpus luteum cyst may need monitoring
- Repeat USG/clinical review in 4–6 weeks if symptoms persist
- Serial CBC/CRP to monitor inflammatory markers
- If pain escalates or fever develops — reassess for interval appendicitis or other acute abdomen
Bottom Line
The CT effectively rules out appendicitis. The likely cause is focal omental fat inflammation (epiploic appendagitis/panniculitis) ± right ovarian corpus luteum contributing to pain. This is a conservative management case — no surgery needed at this stage.
Sources: Sabiston Textbook of Surgery, 21e | Mulholland & Greenfield's Surgery, 7e | Grainger & Allison's Diagnostic Radiology | Sleisenger & Fordtran's GI and Liver Disease
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