Presentation
Right lower quadrant abdominal pain, fever, and leukocytosis.
Patient Data
Coronal T2 and axial T2 with fat saturation sequences demonstrate a dilated, fluid-filled appendix with a large appendicolith and pericecal edema. A single intrauterine gestation in the third trimester is present.
Case Discussion
This patient presented with right lower quadrant abdominal pain, fever, and leukocytosis. In the setting of pregnancy, many of the typical symptoms of appendicitis, such as nausea and vomiting, as well as leukocytosis could be attributed to normal changes associated with pregnancy. Thus, the use of proper diagnostic imaging is essential in the work-up of pregnant patients with suspected acute appendicitis.
The first-line imaging modality used in the diagnosis of a pregnant patient with suspected acute appendicitis is graded compression ultrasonography 1. However, visualization of the appendix may be difficult in pregnant patients due to the associated anatomical changes to the gravid abdomen. Thus, the use of MRI is the next preferred test given that it avoids the ionizing radiation associated with the use of computed tomography. The use of MRI in the diagnosis of acute appendicitis in pregnancy was found to have a sensitivity and specificity of 96.8% and 99.2%, respectively 2.
Given this patient's presenting symptoms and leukocytosis, the differential diagnoses were acute appendicitis, physiological symptoms of pregnancy, and pyelonephritis. A T2-weighted MRI was performed showing a dilated, fluid-filled appendix with a large appendicolith and pericecal edema, strongly suggesting the diagnosis of acute appendicitis. This patient ultimately underwent a successful laparoscopic appendectomy without complications.
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