Misdiagnosis of primary epiploic appendagitis

The authors determined the radiological misdiagnosis rate of primary epiploic appendagitis (PEA) and its impact on patient management and hospital resource use.

A total of 660 computed tomography scans performed for clinically suspected diverticulitis (348 cases) or appendicitis (312 cases) were reviewed for cases meeting strict radiological criteria for PEA. Retrospective interpretations were compared with radiological reports. Medical records and hospital cost data were reviewed to estimate impact on patient management and resource use.

Eleven scans (2%) met criteria for PEA. Seven scans were initially misdiagnosed as diverticulitis (6 patients) or appendicitis (1 patient). All misdiagnosed patients were hospitalized (mean 4.3 days); 6 received antibiotic therapy. Average cost per patient was $4,117. Four scans were initially correctly diagnosed as PEA. One patient was hospitalized (1 day); none received antibiotic therapy. Average cost per patient was $1,205.

Radiological misdiagnosis of PEA leads to unnecessary hospitalization, medical treatment, and overuse of hospital resources.