Focal infarction of lesser omentum.

A 25-year-old man came to the emergency department complaining of continuous right para-umbilical pain radiating to the epigastric midline since the previous night. Pain was associated with tenderness. He had no fever and the rest of the physical examination was normal. Laboratory studies showed a normal white blood cell count and C-reactive protein level was 11 mg/L (normal < 10 mg/L). Pain was relieved by paracetamol. Abdominal ultrasound (Fig. A) showed a painful incompressible hyperechoic pre-pancreatic ovoid mass (white arrows) about 4 centimeters wide, with low background attenuation, located on the epigastric mid-line between the liver (black star), the pancreas (white star), and left to the duodenum (curved arrow). MDCT (Fig. B) confirmed a slightly hyperdense mass (white arrows) of 2,8 x 1,7 x 3,5 cm with well-defined contours and containing hyperdense streaks (curved arrow), localised in the lesser omentum – contiguous to gastric arteries – on different multiplanar reformated views, along the stomach lesser curvature (white star). The diagnosis of infarction of the lesser omentum was proposed, and conservative treatment was introduced. He received oral analgesic and antiinflammatory drugs, and became asymptomatic in a few days.