Acute appendicitis is largely a clinical diagnosis with the use of imaging reserved for complicated cases or the elderly with concern over an underlying colorectal malignancy.

Ultrasound remains the first line investigation given the typically young patient demographics for the condition and in females the importance of gynecological pathology in the differential diagnoses.

Clinicians and radiologists have a duty to use radiation wisely following the application of clinical acumen and interdisciplinary discussion.

The CT shows a full house of signs:

• a thick walled appendix
• a fluid filled distended appendix
• several luminal calcified appendicoliths