On CT, epiploic appendagitis appears as a small, fat-density, oval lesion adjacent to the colon, typically measuring between 1 to 4 cm, with a hyperattenuating rim and often a central dot, representing the thrombosed vein. The lesion’s fat density differentiates it from other soft tissue masses, while the hyperattenuating rim reflects peritoneal inflammation encircling the appendage, a feature that becomes more evident with contrast enhancement. The central dot sign, indicative of a thrombosed vein, is a hallmark feature that enhances diagnostic confidence and allows differentiation from other entities like omental infarction.Surrounding fat stranding is commonly observed; however, it is localized and less pronounced compared to other inflammatory conditions such as diverticulitis or omental infarction. This distinction is critical in guiding accurate diagnosis. Additionally, the absence of bowel wall thickening, perforation, or lymphadenopathy serves as a key exclusionary criterion to differentiate epiploic appendagitis from diverticulitis, which often presents with these findings. The lesion’s specific location adjacent to the colon and its lack of vascularity on Doppler studies further reinforce the diagnosis, helping radiologists rule out malignancy or vascular-related conditions.Advanced imaging techniques may also aid in the diagnosis. For instance, multiplanar reconstructions and three-dimensional CT imaging can provide additional insights into the lesion’s spatial relationship with adjacent structures. Identifying these specific features is crucial because misdiagnosis could lead to unnecessary surgical interventions or treatments, causing undue stress for the patient.Epiploic appendagitis is usually self-limiting, resolving spontaneously within days to weeks. Conservative management, including nonsteroidal anti-inflammatory drugs (NSAIDs) and analgesics, is often sufficient to alleviate symptoms. Early and accurate diagnosis can significantly reduce healthcare costs and avoid invasive procedures, underscoring the importance of familiarity with its imaging characteristics among radiologists [5,6].