Appendices epiploicae of the large bowel. Sonographic appearance and differentiation from peritoneal seeding

Solid hyperechogenic nodules of different sizes and shapes surrounded by ascitic fluid were seen growing from the peritoneal surface of the large bowel in three patients with biopsy-proven alcoholic liver cirrhosis; they were spaced at regular intervals along the course of the colon. The same images were visible during in vitro examination of two surgical specimens of the large bowel and corresponded to appendices epiploicae of different sizes. The appendices epiploicae can be identified by sonography only when surrounded by fluid; their shape may be similar to that of peritoneal tumors. Careful analysis of both the relationships of the appendices epiploicae with the outer surface of the large bowel and of their regular spacing along the course of the colon itself may help to avoid possible misinterpretations.