Helical CT Evaluation of Acute Right Lower Quadrant Pain: Part I, Common Mimics of Appendicitis

Jinxing Yu; Ann S. Fulcher; Mary Ann Turner; Robert A. Halvorsen

Disclosures

Am J Roentgenol. 2005;184(4):1136-1142. 

In This Article

Right Colonic Carcinoma

Right colonic carcinoma may present with acute lower abdominal pain, usually due to obstruction or perforation. On helical CT, marked asymmetric colonic wall thickening, short segment involvement, and abrupt change from a normal to an abnormal segment of colon are the key features that help to distinguish this from other entities. However, the diagnosis becomes more challenging and may mimic appendicitis when perforation occurs and results in fat stranding, fluid collections, and abscess formation in the RLQ (Figs. 14A, and 14B).

59-year-old woman with fever and acute right abdominal pain. A , Axial CT image shows mass in right abdomen, containing gas and fluid with adjacent fatty stranding ( solid arrows ) consistent with abscess. Right renal hemorrhagic cyst ( open arrows ) was noted and confirmed on follow-up sonography (not shown). B , Axial CT image obtained 1 cm inferior to A shows marked wall thickening of short segment of right colon ( arrows ). Right colonic carcinoma with perforation was confirmed surgically.

59-year-old woman with fever and acute right abdominal pain. A , Axial CT image shows mass in right abdomen, containing gas and fluid with adjacent fatty stranding ( solid arrows ) consistent with abscess. Right renal hemorrhagic cyst ( open arrows ) was noted and confirmed on follow-up sonography (not shown). B , Axial CT image obtained 1 cm inferior to A shows marked wall thickening of short segment of right colon ( arrows ). Right colonic carcinoma with perforation was confirmed surgically.

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