Epiploic appendagitis: An overlooked cause of acute abdominal pain

Table 4 Comparison of radiologic modalities in the diagnosis of epiploic appendagitis

Feature	Ultrasound	Computed tomography	Magnetic resonance imaging
Utility	First-line in young, thin patients; pregnancy; bedside availability	Gold standard; most widely used modality	Alternative when CT is contraindicated (e.g., pregnancy, allergy to contrast)
Key imaging features	Hyperechoic, non-compressible ovoid mass; no Doppler flow; mild surrounding edema	Oval fat-density lesion with hyperattenuating rim (“ring sign”) and central dot sign	T1-hyperintense lesion with T2-hyperintense rim; no contrast enhancement
Sensitivity/specificity	Operator-dependent; moderate sensitivity and specificity	High sensitivity and specificity (> 90%)	Comparable to CT in skilled hands; limited data
Advantages	No radiation; portable; repeatable	High resolution; widely available; detailed fat and bowel wall visualization	Excellent soft tissue contrast; radiation-free
Limitations	May be limited by obesity or bowel gas; user expertise critical	Radiation exposure; contrast may be needed	High cost; limited availability; longer scan time
Preferred use	Initial screening in selected populations (e.g., pediatrics, pregnant women)	Routine evaluation of acute abdominal pain	Problem-solving tool or radiation-sensitive patients

CT: Computed tomography.