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Acute appendicitis - arrowhead sign

Case contributed by Pir Abdul Ahad Aziz Qureshi
Diagnosis certain

Presentation

Right iliac fossa pain.

Patient Data

Age: 55 years
Gender: Female

The appendix is dilated with significant periappendiceal fat stranding. Note there is focal symmetric thickening at the cecal apex with funnelling of oral contrast in the cecal apex with the tip pointing towards the base of the inflamed appendix.

Case Discussion

The arrowhead sign refers to the focal thickening of the cecal pole with funnelling of oral contrast into the cecal apex assuming an arrowhead appearance which points towards the base of the appendix.

It is seen as a secondary sign in acute appendicitis and represents an inflammatory extension from the appendix to the cecum.

The patient subsequently went on to have an appendectomy and is doing well on follow-up.

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