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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

From the case: Appendicitis

Modality: CT

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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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appendicitis

References:

Pinto leite N, Pereira JM, Cunha R et-al. CT evaluation of appendicitis and its complications: imaging techniques and key diagnostic findings. AJR Am J Roentgenol. 2005;185 (2): 406-17. AJR Am J Roentgenol (citation) - Pubmed citation