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Appendicitis

Case contributed by: Dr Charlie Chia-Tsong Hsu

Presentation:

43 year old female presented with fever and epigastric pain. She has raised CRP and WCC. General surgical registrar requested a CT abdomen and pelvis. Referring differential diagnoses include gastric/duodenal ulcer and duodenitis.

Patient Data:

Age: 43
Gender: Female
Race: Caucasian
Modality: CT

There is appendiceal wall hyperenhancement and wall thickening measuring up to 7mm on axial images.   No obvious fat stranding around the appendix. 

Case Discussion:

Pinto Leite et al proposed an Algorithm for Interpretation of Appendicitis CT in Symptomatic Patients1

  • 1. Excludes appendicitis
    • CT findings: < 6-mm appendix or  > 6-mm appendix completely gas-filled.
      Recommendation : Work up other causes of RLQ pain
  • 2. Possible appendicitis
    • CT findings: 6- to 10-mm appendix without any other CT signs.
      Recommendation : Observation if symptomatic
  • 3. Probable appendicitis
    • CT findings: 6- to 10-mm appendix +wall thickening +  wall hyperenhancement (no fat stranding).
      Recommendation : Surgery if symptomatic
  • 4. Definite appendicitis
    • CT findings: > 10-mm appendix or 6- to 10-mm appendix + wall thickening + wall hyperenhencement+ fat stranding.
      Recommendation: Surgery if symptomatic

In our case example above the imaging findings are suggestive of "probable appendicitis". Patient subsequently underwent appendicectomy without complication.

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