Image by Genevieve Carbonatto
A 52 year old lady presented to the Emergency department with acute , severe, epigastric pain and vomiting. A point of care ultrasound was performed which showed a normal gall bladder with no stones. Insonating over the area of maximal tenderness which was just below the xiphisternum showed a rounded hyperechoic mass surrounded by a hypoechoic stripe which was very tender to compression. The mass was non compressible. This was confirmed to be an epiploic fat torsion on CT. The patient was admitted for analgesia and treated conservatively.
Epiploic appendages are small benign outpouchings of visceral peritoneum that contain fat and small blood vessels. They can undergo torsion. This is rare.