What alternative diagnosis do these CT images show?
The full details of this case are over at the open access article in BJR case reports. In summary, the scan shows a large mass within the upper abdomen in close proximity to the pancreatic tail, with central fat density, marginal enhancement, a distended vessel coursing through the centre and hazy increased density of the fat outside of the structure. A diagnosis of intra-abdominal focal fat infarction (IFFI) was made and she was treated conservatively.
Subsequently, she re-presented with further pain and elevated inflammatory markers. A repeat CT scan again demonstrated the well-defined mass, but now with the development of fluid attenuation within the centre and several pockets of air:
Radiologically guided percutaneous drains were inserted into the area of liquefaction and subsequent microbiology analysis revealed mixed coliform bacilli; targeted antibiotics were administered.
The collection resolved on subsequent imaging.
Identification of radiological features of IFFI is very helpful in establishing a diagnosis and may negate the need for surgical intervention.