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

Crohn's Disease

Crohn's disease may present as acute RLQ pain with fever and elevated WBC, mimicking appendicitis. Helical CT findings in Crohn's disease include bowel wall thickening, narrowing of the lumen, mesenteric fatty stranding, creeping fat, and skip lesions.[4] (Fig. 4). Abdominal abscesses may develop adjacent to segments of bowel severely affected by Crohn's disease (Figs. 5A, and 5B). The long segmental wall thickening of the terminal ileum, the center of inflammation away from the appendix, and circumferential symmetric thickening of the cecum are the major features that differentiate Crohn's disease from appendicitis.

43-year-old man with Crohn's disease. Axial CT scan shows circumferential wall thickening of cecum ( solid arrows ) and terminal ileum ( open arrow ).

24-year-old woman with Crohn's disease and abscess. sb = small bowel. A , Axial CT scan shows circumferential wall thickening of distal small bowel and cecum (C) with adjacent fat stranding ( arrow ). B , sb = small bowel. Axial CT scan obtained inferior to A shows large abscess ( arrows ) in mesentery adjacent to long segment of distal small bowel with wall thickening.

24-year-old woman with Crohn's disease and abscess. sb = small bowel. A , Axial CT scan shows circumferential wall thickening of distal small bowel and cecum (C) with adjacent fat stranding ( arrow ). B , sb = small bowel. Axial CT scan obtained inferior to A shows large abscess ( arrows ) in mesentery adjacent to long segment of distal small bowel with wall thickening.

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