Hyperenhancing appendix: early sign of acute appendicitis on CT

Case contributed by Chris O'Donnell
Diagnosis certain


12 hours of right iliac fossa pain with mild fever. US suggestive of acute appendicitis, CT for confirmation.

Patient Data

Age: 70
Gender: Male

The appendix is a little swollen (8mm X-sectional diameter) but the lumen is not dilated nor is there inflammation in adjacent fat although there is uniform hyperenhancement of the appendiceal wall as compared with the adjacent bowel.  Acute appendicitis was confirmed at surgery.

Case Discussion

There are multiple CT findings in acute appendicitis including wall thickening, mucosal edema and dilatation of the lumen together with surrounding fat stranding.  Hyperenhancment is also an unusual but recognized early sign of acute appendicitis reflecting hypervascularity as seen on duplex US.  In this case it is the only definite sign as the surrounding fat is not inflammed and the lumen not dilated.

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