Presentation
Periumbilical pain starting one day ago, subsiding on the day of the examination.
Patient Data
The urinary bladder depicts echogenic debris, but the abdominal examination is otherwise unremarkable. Further laboratory and clinical evaluation was recommended.
The appendix appears slightly thickened measuring about 8 mm in its transverse diameter with a thick enhancing wall but without significant stranding of the adjacent fat planes or fluid collections. The appendix extends medially towards the right common iliac artery and vein and superiorly to reach the aortic bifurcation.
The findings are suggestive of early acute appendicitis.
Case Discussion
CT is the most sensitive modality to detect appendicitis. One of the biggest challenges of imaging the appendix is finding it. The location of the base of the appendix is relatively constant, located roughly between the ileocecal valve and the apex of the cecum. This relationship is maintained even when the cecum is mobile. The location of the tip of the appendix is much more variable, especially as the length of the appendix has an extensive range (2-20 cm). The most common location is behind the cecum, ascending retrocecal.