Presentation
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
From the case:
Appendicitis
Loading images...
Coronal C+ portal venous phase
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
- CT findings: < 6-mm appendix or > 6-mm appendix completely gas-filled.
- 2. Possible appendicitis
- CT findings: 6- to 10-mm appendix without any other CT
signs.
Recommendation : Observation if symptomatic
- CT findings: 6- to 10-mm appendix without any other CT
signs.
- 3. Probable appendicitis
- CT findings: 6- to 10-mm appendix +wall thickening + wall hyperenhancement (no fat stranding).
Recommendation : Surgery if symptomatic
- CT findings: 6- to 10-mm appendix +wall thickening + wall hyperenhancement (no fat stranding).
- 4. Definite appendicitis
- CT findings: > 10-mm appendix or 6- to 10-mm appendix +
wall thickening + wall hyperenhencement+ fat stranding.
Recommendation: Surgery if symptomatic
- CT findings: > 10-mm appendix or 6- to 10-mm appendix +
wall thickening + wall hyperenhencement+ fat stranding.
In our case example above the imaging findings are suggestive of "probable appendicitis". Patient subsequently underwent appendectomy without complication.
Unable to process the form. Check for errors and try again.