Intraoperative findings: acute inflammed appendicitis.

Radiation dose to fetus should be essential part of consideration to justify CT scan study for pregnant patient, especially CT abdomen/pelvis. As the first line of imaging modality ultrasound unable provides the conclusive findings in this case, this patient proceeded with contrast enhanced CT abdomen and pelvis.

The better next imaging modality after ultrasound scan for case of suspected acute appendicitis should be the radiation-free MRI abdomen (without contrast gadolinium as it is contraindicated during pregnancy), by using some specific sequence such as
1. Single-shot turbo spin echo (SSH-TSE) T2-weighted images (WI) in axial, coronal and sagittal planes for anatomy of the appendix
2. T2 weighted fat saturation to look for edema and fluid collection
3. DWI/ADC sequence to look for any restricted diffusion at the cecal pole.

Abdominal pain in pregnancy protocol (MRI)