Presentation
Right lower quadrant pain
The appendix is fluid filled, thick with hyperenhancing walls, and periappendiceal stranding.
Case Discussion
Findings: The appendix is fluid filled and thick with hyperenhancing walls, periappendiceal stranding, appendicolith
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Objectives:
To review the anatomy of the appendix and how to identify it on CT
To review the CT signs of uncomplicated appendicitis
To review the complications of appendicitis and their imaging appearance
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Protocolling:
Contrast vs non-contrast CT – discuss oral and IV contrast use
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Key Points:
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Identifying the appendix on CT:
Follow the colon from the rectum to the cecum
Identify the ileo-cecal valve (sail sign, fat density)
Appendix should arise from the cecum DISTAL (not necessarily inferior) to the IC valve, AND from the same side of the cecum as the IC valve
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CT signs of uncomplicated appendicitis
Dilated appendix (>7mm)
Hyper-enhancing, thick appendix wall
Focal cecal thickening (cecal bar sign, arrow sign)
Periappendiceal stranding
Appendicolith
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Complications to look for:
Perforation - extraluminal gas, discontinuous wall, fluid collection
Abscess (in the setting of perforation)
Thrombosis of portal venous system (SMV, portal vein)
Hepatic abscess
Fistula
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Differential diagnosis:
Tumors of the appendix
Chronic appendicitis, as in Crohn appendicitis
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