Imaging of Omental Pathologies with Histopathological Correlation

Background: The omentum, a dynamic peritoneal fold, is frequently affected by infective, inflammatory, and neoplastic conditions. Its nonspecific clinical presentation makes imaging and histopathological correlation essential for accurate diagnosis. Aim: To evaluate the imaging features of omental pathologies and correlate them with histopathological findings for diagnostic accuracy. Methods: This prospective observational study was conducted at Silchar Medical College & Hospital, Assam, over 12 months (September 2023?August 2024). A total of 49 patients with clinically suspected omental disease underwent imaging (USG, CT, and MRI). Ultrasound-guided FNAC or biopsy was performed, and findings were correlated with histopathology. Data were analyzed using descriptive statistics and diagnostic metrics, with ethical approval obtained prior to study initiation. Results: Infective pathologies were most common (46.9%), followed by neoplastic (34.7%) and non-neoplastic (14.3%) causes. Tubercular peritonitis accounted for 52.2% of infective cases. Most patients were aged 21?60 years (77%), with a slight female predominance. USG revealed ascites, peritoneal thickening, omental caking, and mesenteric thickening in TB peritonitis, while CT was superior in detecting peritoneal deposits, matted bowel loops, and irregular thickening in neoplastic disease. Peritoneal carcinomatosis was the leading secondary omental tumor (83.3%). Conclusion: Imaging modalities, especially CT and USG, provide valuable diagnostic clues in omental diseases. However, histopathological confirmation remains the gold standard, ensuring precise diagnosis and guiding optimal clinical management.