Differential Diagnosis for Non-Contrast CT Abdomen Findings
Single Most Likely Diagnosis
- Intraperitoneal Focal Fat Infarction: This diagnosis is considered the most likely due to the specific mention of "area of fat stranding along the ventral descending colon" which aligns with the presentation of focal fat infarction, a condition where there is necrosis of the fatty tissue, often due to trauma, but can also be spontaneous.
Other Likely Diagnoses
- Epiploic Appendagitis: This condition involves the inflammation of the epiploic appendages, which are small, fatty structures attached to the colon. It can present with fat stranding on imaging and is often considered in the differential for focal abdominal pain and fat stranding.
- Omental Infarction: Similar to focal fat infarction, omental infarction involves the necrosis of the omentum, a fold of tissue in the abdomen, and can present with abdominal pain and fat stranding on imaging.
- Diverticulitis: Although more commonly associated with the sigmoid colon, diverticulitis (inflammation of a diverticulum) can occur in any part of the colon and might present with fat stranding adjacent to the affected colon segment.
Do Not Miss Diagnoses
- Appendicitis: Although the location described (along the ventral descending colon) is not typical for appendicitis, which usually involves the appendix near the base of the caecum, an ectopic appendix or an appendix that has migrated could potentially present in this manner. Missing appendicitis can lead to severe consequences, including perforation and peritonitis.
- Intestinal Ischemia or Infarction: Any condition leading to reduced blood flow to the intestines can cause severe abdominal pain and might show fat stranding on CT due to the inflammatory response. This is a critical diagnosis to consider due to its high morbidity and mortality if not promptly treated.
- Perforated Viscus: A hole in any part of the gastrointestinal tract can lead to leakage of contents into the abdominal cavity, causing peritonitis. Fat stranding could be seen adjacent to the site of perforation, and this condition requires immediate surgical intervention.
Rare Diagnoses
- Sclerosing Mesenteritis: A rare condition characterized by inflammation and scarring of the mesentery, which can present with a variety of abdominal symptoms and might show fat stranding or a mass on imaging.
- Intra-abdominal Lymphoma: Although lymphoma can involve any part of the body, intra-abdominal lymphoma might present with masses or fat stranding if it involves the mesentery or other fatty tissues within the abdomen.
- Abdominal Wall Endometriosis: In rare cases, endometrial tissue can implant in the abdominal wall, including near the colon, and cause cyclic pain and potentially show fat stranding on imaging due to the associated inflammation.