Case contributed by Charlie Chia-Tsong Hsu
Diagnosis almost certain


Fever and epigastric pain. She has raised CRP and WCC. General surgical registrar requested a CT abdomen and pelvis. Referring differential diagnoses include gastric/duodenal ulcer and duodenitis.

Patient Data

Age: 45 years
Gender: Female

There is appendiceal wall hyperenhancement and wall thickening measuring up to 7mm on axial images.   No obvious fat stranding around the appendix. 

Case Discussion

Pinto Leite et al proposed an Algorithm for Interpretation of Appendicitis CT in Symptomatic Patients1

  • 1. Excludes appendicitis
    • CT findings: < 6-mm appendix or  > 6-mm appendix completely gas-filled.
      Recommendation : Work up other causes of RLQ pain
  • 2. Possible appendicitis
    • CT findings: 6- to 10-mm appendix without any other CT signs.
      Recommendation : Observation if symptomatic
  • 3. Probable appendicitis
    • CT findings: 6- to 10-mm appendix +wall thickening +  wall hyperenhancement (no fat stranding).
      Recommendation : Surgery if symptomatic
  • 4. Definite appendicitis
    • CT findings: > 10-mm appendix or 6- to 10-mm appendix + wall thickening + wall hyperenhencement+ fat stranding.
      Recommendation: Surgery if symptomatic

In our case example above the imaging findings are suggestive of "probable appendicitis". Patient subsequently underwent appendectomy without complication.

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