Presentation
Acute abdominal pain right lower quadrant, worsening pain over the last 10 hours.
Patient Data
There is evidence of ruptured appendicitis with an enlarged appendix and extensive
inflammatory changes in the right lower quadrant. Two small locules of extraluminal air noted in the right lower quadrant. No discrete abscess.
Case Discussion
This case describes a patient presenting with worsening RLQ abdominal pain over the last 10 hours. Clinical suspicion of acute appendicitis was high and a non-contrast CT was performed. The results of the imaging confirmed the suspected diagnosis.
Acute appendicitis refers to acute inflammation of the vermiform appendix. CT abdomen is the diagnostic imaging modality of choice for the diagnosis of acute appendicitis in non-pregnant adult patients. Abdominal ultrasonography is the preferred imaging study for pregnant patients and children.
CT findings supportive of the diagnosis of acute appendicitis include: distension of the appendix to a diameter > 6 mm, periappendiceal fat stranding, and visualization of an appendiceal fecalith (focal hyperdense structure within appendiceal lumen).
Complications may also be noted on imaging and support the diagnosis of acute appendicitis. These complications include perforation (manifesting as pneumoperitoneum on imaging) and abscess formation.
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