A 56-year-old man presented to the emergency department with acute upper abdominal pain and mild leucocytosis. The pain was not relieved by intravenous analgesia. Computed tomography of the abdomen and pelvis demonstrated a focal area of fat stranding with a thin peripheral rim of high attenuation and a punctate central hyperdense dot in the vicinity of the falciform ligament. The diagnosis of focal infarction of the falciform ligament fatty appendage was made based on the imaging findings. The patient responded well to conservative management and was discharged for outpatient follow-up. Focal infarction of the falciform ligament fatty appendage is extremely rare and can mimic various causes of acute abdomen that require emergency surgery. Hence, correct radiological diagnosis is essential to avoid unnecessary surgical intervention. We herein discuss the similarities and differences with other common companion cases such as epiploic appendagitis and omental infarction.

INTRODUCTION: Thyroid fine-needle aspiration cytology (FNAC) is an established investigation for the preoperative evaluation of thyroid nodules and is often done under ultrasonography guidance. While its accuracy has been widely reported, there is little evidence in the literature on the approach to non-diagnostic cytology results. In our study, we aimed to determine the diagnostic performance of ultrasonography-guided thyroid FNAC for the preoperative diagnosis of thyroid cancer at our institution and evaluate the significance of a non-diagnostic thyroid FNAC. METHODS: We retrospectively reviewed the thyroid ultrasonography studies and medical records of all patients who underwent both thyroid FNAC and subsequent thyroid surgery at our institution from 2011 to 2013. FNAC results were correlated with the final histological diagnosis from surgery and the ultrasonography studies were reviewed for suspicious sonographic features. RESULTS: FNAC predicted malignancy with sensitivity, specificity, positive predictive value, negative predictive value, false positive rate, false negative rate and total accuracy of 90.7%, 53.6%, 43.3%, 93.7%, 46.4%, 9.3% and 64.1%, respectively. We found that only one of 26 nodules with non-diagnostic FNAC results was proven malignant on a second FNAC and subsequent thyroidectomy. CONCLUSION The accuracy of ultrasonography-guided FNAC at our institution was comparable to that reported in the literature. There appears to be very low probability of malignancy in sonographically benign nodules with initial non-diagnostic FNAC results.