 Hello everyone. My name is Dr. Surendra Suvaslingh Gawar currently studying as resident in the radio diagnosis department of Dr. Balasaheb Vikhya Parties Rural Medical College, Loni, Amad Nagar. Title of my paper presentation is Epiploic appendicitis, presenting as a case of acute abdomen, a case report. Epiploic appendicitis is a rare self-limiting ischemic inflammatory process that affects the appendicitis epiploic of the colon. It may either be primary, spontaneous or secondary to the adjacent pathology. It usually affects patients in their second to fifth decades with a redilection for women and obvious individuals, presumably due to larger appendages. Patients typically present with abdominal pain and guarding. It many a times is indistinguishable from diverticulitis and acute appendicitis depending on the location of the pain. Because there is focal peritoneal irritation, pain is more localized than with other causes of acute abdominal pain. Epiploic appendicitis denotes inflammation of one or more appendicitis epiploike, which number 50 to 100 and are distributed along the large bowel with variable frequency. That is, the maximum are in rectosignal junction of the colon and the least are noted in the descending colon. The pathogenesis of epiploic appendicitis is due to a torsion of large or pedunculated appendage epiploike or spontaneous thrombosis of the venous outflow which results in ischemia and necrosis of the epiploic appendage. Now, the case which presented to our institute was a 33-year-old male that came to OPD with pain, complaints of pain in abdomen, which were incidents in onset gradually progressive over duration of presentation since two days. The pain was non-radiating, not associated with any aggravating or a living factors. There were no history of fever, urinary, bowel, complaints, trauma, no history of chronic comorbidities, no history of allergies or any drug consumption, no similar family history and no similar complaints in the past. On admission, patients vitals were stable. On examination, abdomen was soft with localized focal tenderness over the left eyelid for serration. Laptase for complete blood counts, LFTs, RFTs, serum electrolyte levels, protein levels, coagulation profile were all within normal limits. Radiological investigations were done for the patient to identify the pathology. Radiograph of abdomen and pelvis in erect AP view was done, USG abdomen and pelvis was done, CT scan abdomen and pelvis, plane and contrast was done. The imaging findings were on radiograph of abdomen and pelvis which was done, which were performed using Allenges 800MAs machine revealed that the radiograph of abdomen and pelvis was within normal limits. Abdomen and pelvis on USG was performed on Zario 200 machine with 6 C1 curvilinear transducer at the point of maximum tenderness. There was a 17 x 9 mm size well-defined oval, non-compressible, heterogeneously hyper-equic area with surrounding subtle hyper-equic region. On color dot this study, it did not show any vascularity. There was minimal surrounding fat-standing, however no adjacent bobble or thickening was noted, nor any enlarged lymph nodes were noted. Then the CCT of abdomen and pelvis was done using Siemens somatom perspective 64 rows and 120 slices machine which revealed that there was an 8 x 10 x 5 mm size well-defined oval shaped heterogeneously enhancing hyper dense fat density area. With peripheral hyper dense ring, this sign is also called as hyper attenuating ring sign, adjacent fat-standing. And this area was noted abutting descending colon in left eye leg force origin. However, no adjacent bobble ball thickening was noted and it was noted just beneath the anterior abdominal wall muscle on the left side. There was a tiny central hyper dense area noted within the lesion which likely suggests thrombose vascular pedicle. The radiograph of abdomen and pelvis erect AP view is shown which appears to be within normal limits. USG abdomen and pelvis was done as explained it shows a well-defined non compressible heterogeneously hypoequic area with surrounding hypoequic area. Now this we are provided with limited axial cross section view of CET abdomen and pelvis in the plane images. We can see that there is a well-defined oval shaped hyper dense fat density area with peripheral hyper dense ring that is called as hyper attenuating ring sign and adjacent fat-standing noted. After giving contrast in arterial phase, no enhancement was noted. Then in venous phase, there was heterogeneous slight enhancement and there is evidence of hyper dense tiny area in the center of the lesion which shows thrombose vascular pedicle. We are provided with coronal images of the contrast venous phase which also shows the same lesion heterogeneously enhancing avoid lesion in the left iliac posa region. The sagittal images of venous phase after giving contrast of CET abdomen and pelvis also show the same lesion. The diagnosis was based on history and imaging findings. Then on the imaging differences that were considered were diverticulitis, omental infarction and omental neoplasms. Diverticulitis was ruled out as bobble wall out bulging was not noted. No communication with the bobble wall was noted and no bobble wall thickening was also noted. Omental infarction was ruled out on the basis of imaging findings the size of the lesion which was less than 2 cm and also based on abdominal pain. As omental infarction classically involves right lower cortine and our patient presented with left lower cortine pain. Secondary omental infarction was also ruled out as there was no previous history of any surgery or any intervention. Omental neoplasms were ruled out on the basis of imaging findings as well the omentum elsewhere in the abdomen was within normal limits and not involved. No other pathology was found in the CET abdomen and pelvis scan. After the diagnosis of epiploic appendicitis was made the patient was given supportive treatment with analgesics and fluid therapy and rest following which the patient improved and was discharged from the hospital. The term epiploic appendicitis was the first time employed by Lyme in 1956 and first written description for the same was done in 1986 by Danielson. Epiploic appendicitis is a self-limiting disease and responds well to analgesics, NSAIDs, sometimes mimics acute abdominal conditions for which surgery is required and therefore correct identification on CT prevents unnecessary surgery. Also treatment options for epiploic appendicitis many a times do not involve surgery. Chronically and infacted epiploic appendage may get calcified and detached to form an intraperitoneal loose body also called as peritoneal mice. It may rarely involve the vermiform appendix's epiploic appendage and it is called as epiploic appendicitis of the vermiform appendix. Thus we are making appendicitis both clinically as well as potentially on the CT. Therefore knowing the condition and making the right appropriate diagnosis serves best for the patient, clinician, surgeons as well as the diagnosing radiologist. These are my references. Thank you for your patient hearing.