Acute Appendicitis

This patient presented with vague right flank pain symptoms that started earlier in the day. Findings on CT represent a mild acute presentation of appendicitis. The patient underwent surgery within the day and an inflamed appendix was removed.

The appendix should always be surveyed in the acute abdominal pain setting.

Find the appendix: Locate the ileocecal junction and follow the cecum posteromedially ~1-2 cm. You will find the most difficult appendices to find are the ones that are in patients with RLQ pain! Use your coronal and sagittal images, if needed!
Findings suggestive of acute appendicitis on CT include peri-appendiceal stranding /inflammation, circumferential wall thickening, fluid filled appearance, appendicoliths, apical cecal inflammation/thickening, and/or free peritoneal fluid. Dilatation of the appendix alone is not a strong predictor. Also, gas may be present in a normal appendix or necrotizing appendicitis. Use all of your other clues to decide if the appendix is acutely inflamed.


Reference:
Dahnert, "Radiology Review Manual". 7th ed. page 818.