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Endgames Spot Diagnosis

An uncommon cause of abdominal pain in a young man

BMJ 2018; 360 doi: (Published 04 January 2018) Cite this as: BMJ 2018;360:j5182
  1. Timothy Shao Ern Tan, medical officer,
  2. Foong Koon Cheah, senior consultant radiologist
  1. Department of Diagnostic Radiology, Singapore General Hospital, Singapore
  1. Correspondence to T S E Tan timothy.tan.shao.ern{at}

A 38 year old man with a known testicular germ cell tumour presented with acute right sided abdominal pain but no other symptoms. Clinical examination showed positive Murphy’s sign. Laboratory investigations showed leucocytosis of 10.6×109 (reference range 4.0-9.0×109)/L and serum C reactive protein of 59 (0.2-9.1) mg/L. Serum liver enzymes were unremarkable. A computed tomography scan of his abdomen and pelvis was performed (fig 1). What abnormality does this scan show?

Fig 1

(a) Axial and (b) coronal sections of contrast enhanced computed tomography scan of the abdomen and pelvis at the mid-ascending colon

Short answer

A tubular hypodense lesion surrounding a central linear hyperdensity adjacent to the ascending colon with surrounding inflammatory changes, suggestive of epiploic appendagitis …

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