IS Case 76: Acute Appendicitis
Imaging Sciences URMC
Publication Date: 2009-05-19
History
Patient is a 62-year-old female with right lower quadrant pain, nausea and vomiting.
Diagnosis
Discussion
Acute appendicitis is the result of luminal obstruction and subsequent bacterial overgrowth with infection. Clinical signs include periumbilical pain migrating to the right lower quadrant and/or focal tenderness at McBurney point.
Upon imaging, a dilated appendix of > 0.7 cm has a high sensitivity for acute appendicitis (> 90%). As in this case, accompanying findings include an enhancing, thickened appendiceal wall, appendicolith(s), cecal tip wall thickening and surrounding inflammatory changes. Of note, a normal, gas or contrast-filled appendix may measure up to 1.0 cm without accompanying findings to suggest acute appendicitis. Contrastingly, a 6.0 mm appendix may have several accompanying signs to make the diagnosis. With the advent of multi-detector CT, coronal reformats have become useful for confirming the diagnosis.
In young, thin people, particularly women of child-bearing age and children, ultrasound is an efficacious first line test as it spares the radiation dose and has demonstrated acceptable sensitivity and specificity (85% and 90% respectively). Unfortunately, its use has declined over the past decade.
Complications include perforation, abscess formation, peritonitis, septicemia and liver abscess.
Typical treatment is surgery. If the case is complicated by an abscess, percutaneous drainage may be indicated.
References
- Jeffrey RB. Appendicitis. 9/21/2006. https://my.statdx.com.
- Paulson EK, Harris JP, Jaffe TA, Haugan PA, Nelson RC. Acute appendicitis: added diagnostic value of coronal reformations from isotropic voxels at multi-detector row CT. Radiology. 2005 Jun;235(3):879-85. [PMID: 15833993]
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