An uncommon cause of abdominal pain in a young man
BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.j5182 (Published 04 January 2018) Cite this as: BMJ 2018;360:j5182
- Timothy Shao Ern Tan, medical officer,
- Foong Koon Cheah, senior consultant radiologist
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
- Correspondence to T S E Tan timothy.tan.shao.ern{at}doctors.org.uk
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?
(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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