Case records of the Massachusetts General Hospital. Case 38-2006. A 5-year-old boy with headache and abdominal pain.
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Biomedical subjects
Publications and source records attributed to Pallavi Sagar.
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We have summarized the diffusion-weighed imaging (DWI) findings in a number of different cerebral disorders. In many cases, DWI with the accompanying apparent diffusion coefficient (ADC) map provides additional useful information to the standard imaging sequences. Pathophysiologic mechanisms resulting in baseline normal ADC values and changes with disease processes are not well understood; therefore, caution should be used when prognosticating the outcome of regions with abnormal ADCs. DWI should be used as an adjunct to routine imaging and interpreted in the context of the routine imaging findings and clinical scenario. As our understanding of ADC mechanisms increases and we begin to incorporate information about tissue organization from diffusion tensor imaging or diffusion spectrum imaging, the role of these methods in clinical diagnosis should continue to increase.
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Acute epiploic appendagitis most commonly manifests with acute lower quadrant pain. Its clinical features are similar to those of acute diverticulitis or, less commonly, acute appendicitis. The conditions that may mimic acute epiploic appendagitis at computed tomography (CT) include acute omental infarction, mesenteric panniculitis, fat-containing tumor, and primary and secondary acute inflammatory processes in the large bowel (eg, diverticulitis and appendicitis). Whereas the location of acute epiploic appendagitis is most commonly adjacent to the sigmoid colon, acute omental infarction is typically located in the right lower quadrant and often is mistaken for acute appendicitis. It is important to correctly diagnose acute epiploic appendagitis and acute omental infarction on CT images because these conditions may be mistaken for acute abdomen, and the mistake may lead to unnecessary surgery. The CT features of acute epiploic appendagitis include an oval lesion 1.5-3.5 cm in diameter, with attenuation similar to that of fat and with surrounding inflammatory changes, that abuts the anterior sigmoid colon wall. The CT features of acute omental infarction include a well-circumscribed triangular or oval heterogeneous fatty mass with a whorled pattern of concentric linear fat stranding between the anterior abdominal wall and the transverse or ascending colon. As CT increasingly is used for the evaluation of acute abdomen, radiologists are likely to see acute epiploic appendagitis and its mimics more often. Recognition of these conditions on CT images will allow appropriate management of acute abdominal pain and may help to prevent unnecessary surgery.