Acute appendicitis

Case contributed by Dr Ian Bickle


Classical symptoms of acute appendicitis. Surgeon wishes for a CT.

Patient Data

Age: 20 years
Gender: Male

Dilated thick walled fluid filled appendix containing four calcified appendicoliths. 

One lies at the ostium resulting in obstruction.

No free fluid, free gas or collection.

Annotated image

Annotations indicate the; dilated, thick walled and fluid filled appendix, containing four calcified appendicoliths. 

Case Discussion

Acute appendicitis is largely a clinical diagnosis with the use of imaging reserved for complicated cases or the elderly with concern over an underlying colorectal malignancy.

Ultrasound remains the first line investigation given the typically young patient demographics for the condition and in females the importance of gynecological pathology in the differential diagnoses.

Clinicians and radiologists have a duty to use radiation wisely following the application of clinical acumen and interdisciplinary discussion.

The CT shows a full house of signs:

  • a thick walled appendix
  • a fluid filled distended appendix
  • several luminal calcified appendicoliths
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Case information

rID: 32614
Published: 16th Dec 2014
Last edited: 1st Jan 2021
Inclusion in quiz mode: Included