Thursday, July 10, 2014

OMENTAL INFARCT - ULTRSOUND EVALUATION

                                               POSSIBLE OMENTAL INFARCT

CLINICAL STORY - A 65 yrs old female  developped severe pain abdomen , and occasional vomiting.  Routine blood and urine lab tests were unremarkable . clinically there was a lumpish feel and local tenderness in right lower quadrant .

ULTRASOUND SCAN - Showed a slightly well defined  oval shaped hyperechoic mass of about 92x30x57mm size  in right lower abdomen , corresponding the site of tenderness [ Fig - 1 & 2] . The mass was lodged just deep to abdominal wall & did not reveal appreciable internal vascularity on doppler . No cystic or calcific foci seen . Underlying & adjacent small and large bowel loops were normal sonographically . Trace amount of ascites was present in right iliac fossa . Liver was sightly fatty . Right kidney & pelvic structure were also unremarkable . Appendix was not seen inflammed .  A probable diagnosis of inflammed fat , likey omental infarct was made , & CT scan was suggested .

CT SCAN -  Showed a well defined slightly heterogenic , predominently hypodese mass in right lower abdomen anterior to bowel loops with fat density areas [ Fig 3 &4 ] . No significant vascularity or ontrast uptake was seen . Rest of abdominal structures were unremarkable . A diagnosis of omental infarct was made on the basis of imaging findings .

 Fig - 1 , Sag. & transverse US image right lower quadrant shows an oval subtle 
                                      heterogenic hyperechoic mass just deep to anterior abdominal wall .

                                     Fig 2 - Appearance of the mass with high resolution linear probe

Fig 3


                                                                              Fig 4
Both fig 3 & fig 4 are CT images [both axial & sag reformation ] showing subtle heterogenic predominantly hypodense oval mass in right lower abdomen , anterior to bowel loops , with fat density areas , confirming the mass as - omental infarct
PS- the case study is intended for medical professionals & imaging specialists for academic purpose