J Korean Soc Radiol.  2019 Sep;80(5):992-996. 10.3348/jksr.2019.80.5.992.

Omental Infarction Associated with Rib Cage Anomaly in Achondroplasia: Report of a Rare Case

• Kim TH
• Kim YS

• KMID: 2459027
• DOI: http://doi.org/10.3348/jksr.2019.80.5.992

Abstract

Omental infarction, a rare cause of acute abdominal pain, is usually difficult to diagnose before surgery. Several studies have shown that CT is useful in diagnosing an omental infarction. We report the first case of an omental infarction secondary to rib cage anomaly associated with achondroplasia. Preoperative CT revealed a fatty mass in the anterior perihepatic space and anterior flaring of the ribs. The patient, a 41-year-old man, was diagnosed with omental infarction in the anterior perihepatic space and treated with intravenous painkillers. After discharge, because of recurrent abdominal pain, he was readmitted and successfully underwent laparoscopic partial omentectomy. The mass was confirmed to be an infarcted omentum with fat necrosis and hemorrhage. Thus, omental infarction should be considered as a differential diagnosis for acute abdominal pain, especially in patients with achondroplasia. Contrast-enhanced abdominal CT can help in correctly diagnosing a suspected omental infarction.

MeSH Terms

Abdomen, Acute
Abdominal Pain
Achondroplasia*
Adult
Diagnosis, Differential
Fat Necrosis
Hemorrhage
Humans
Infarction*
Omentum
Ribs*
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Omental infarction in a 41-year-old achondroplasia patient, complaining with acute abdominal pain. A–E. Axial (A) and coronal (B) CT scans show a fatty mass (arrows) with central mixed soft-tissue attenuation in the anterior aspect of the liver (segments IV and VIII). CT scans also show an ill-defined arterial-enhancing lesion and indentation at the adjacent liver parenchyma. The axial (A) CT scan also shows anterior flaring of both ribs (arrowheads). The intraoperative image (C) shows the greater omentum found between the anterior abdominal wall and liver surface; the trapped segment is grossly necrotic and is adhered to the abdominal wall and adjacent liver surface (arrows). The surgeon successfully resected the trapped and infarcted omentum and controlled liver surface bleeding with argon plasma coagulation (D). The posteroanterior chest radiograph (E) shows shortening of anterior ribs and anteriorly flared ribs (arrows). A horizontal arrangement of rib is also seen, probably due to kyphoscoliosis, which is accompanied by achondroplasia.

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