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

Acute Appendicitis

Acute appendicitis (Figs. 1A, and 1B) manifests on CT as enlargement of the appendix with a diameter greater than 6 mm, thickened wall with enhancement, periappendiceal fatty stranding, and sometimes with an appendicolith, or focal thickening of terminal ileum or cecum.[1,2,3] In early or mild appendicitis, the appendix may remain normal in size. The thickened wall with enhancement may be the only major finding on CT (Fig. 2). A focal defect in the wall of the inflamed appendix (Figs. 3A, and 3B), appendicolith outside the appendix, periappendiceal fluid collection, or extraluminal air near the appendix indicates perforation of the appendix.

22-year-old man with acute appendicitis. C = cecum. A , Axial CT image shows enlarged appendix ( arrowhead ) and fat stranding in right lower quadrant ( arrowheads ) posterior and medial to cecum. B , Axial CT scan obtained inferior to A shows dilated appendix arising from cecum with wall enhancement and thickening ( arrows ).

22-year-old man with acute appendicitis. C = cecum. A , Axial CT image shows enlarged appendix ( arrowhead ) and fat stranding in right lower quadrant ( arrowheads ) posterior and medial to cecum. B , Axial CT scan obtained inferior to A shows dilated appendix arising from cecum with wall enhancement and thickening ( arrows ).

27-year-old man with right lower quadrant pain for 1 day and low-grade fever. A , Axial CT image shows mildly enhanced appendix ( arrows ) with diameter of 6 mm and minimal periappendiceal fatty stranding consistent with early acute appendicitis.

27-year-old man with perforated acute appendicitis. A , Axial CT scan shows extensive fat stranding and fluid collection ( arrows ) surrounding enhanced and dilated appendix (A). Adjacent small bowel (sb) shows wall thickening. B , Axial CT scan obtained inferior to A shows defect ( arrowheads ) in inflamed appendiceal wall (A), indicating perforation. Extensive fat stranding and fluid collection ( arrows ) are present.

27-year-old man with perforated acute appendicitis. A , Axial CT scan shows extensive fat stranding and fluid collection ( arrows ) surrounding enhanced and dilated appendix (A). Adjacent small bowel (sb) shows wall thickening. B , Axial CT scan obtained inferior to A shows defect ( arrowheads ) in inflamed appendiceal wall (A), indicating perforation. Extensive fat stranding and fluid collection ( arrows ) are present.

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