Right iliac fossa pain, nausea and vomiting. History of chronic renal disease.
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There is a marked inflammatory process centered in the right iliac fossa. The normal appendix is not visualized. There are two air and fluid containing collection is in the right iliac fossa. The more medial and superior collection near the midline measures 4.0 x 5.0 cm and the more lateral and inferior collection which is more multiloculated abutting the cecal pole and terminal ileum measures approximately 5.5 x 4.8 cm. Mild stranding is also seen in the right paracolic gutter. Allowing for the limits of a noncontrast study, the visualized solid organs of the abdomen appear unremarkable apart from renal cysts. There is no ascites elsewhere. No abnormally enlarged lymph nodes are identified in the abdomen. There is no generalized pneumoperitoneum. The visualized lung bases are clear.
CT is often requested for cases of clinically suspected appendicitis. The role of CT is to both help make a diagnosis, and also to look for complications such as perforation and abscess formation. In older adults, this is also to evaluate for other underlying pathology that may alter the surgical management.
In this case, CT shows a marked inflammatory process with two collections in the right iliac fossa, most likely due to localized perforation secondary to appendicitis. Differentials include perforated cecal tumor or cecal diverticulitis.