Presentation
Right lower quadrant pain, elevated inflammatory markers.
Patient Data
Intravenous contrast material not administered due to renal failure.
NGT in stomach.
Abdominal aorta of normal diameter, shows mural calcifications.
The appendix is thickened up to 11.5 mm in diameter and does not fill up with contrast material except for its origin. Minute amount of dense fluid contiguous with the appendix. Marked surrounding fat stranding and non-enlarged reactive lymph nodes. 7 cm-long segment of terminal ileum with thickened wall and narrowed lumen in close proximity to appendix.
Case Discussion
Radiographic picture most compatible with phlegmonous appendicitis with reactive ileal wall thickening; however, primary pathology of the terminal ileum (e.g. IBD) with reactive appendicitis should also be considered.
The patient was taken to surgery, where the former was confirmed.
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