Appendicitis (with thickening of the terminal ileum)

Case contributed by Melbourne Uni Radiology Masters


Right iliac fossa pain.

Patient Data

Age: 62 years
Gender: Male

CT Abdomen and pelvis

The appendix is swollen measuring up to 9.5 cm in diameter with a proximal hyperdense appendicolith. There are adjacent fluid and fat stranding extending into the pelvis. In addition, there is the appearance of a peripherally enhancing collection anterior to the appendix which is continuous with the distal appendix. No free gas. There is marked mural thickening of the distal ileum over approximately 10 cm. Several prominent mesenteric lymph nodes. No aortocaval lymphadenopathy. The kidneys, adrenals, spleen, pancreas and liver are normal in appearance.

Case Discussion

The appearances, in this case, are those of a calcified appendicolith and acute appendicitis, but the presence of marked mural thickening of the ileum, although probably reactive in nature, bring other differentials such as inflammatory bowel disease. Acute appendicitis has been confirmed at laparotomy with histological confirmation. 

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Case information

rID: 42432
Published: 20th Jan 2016
Last edited: 16th Jul 2018
Tag: rmh
Inclusion in quiz mode: Included

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