What are some differential diagnoses?
Mesenteric adenitis, terminal ileitis, epiploic appendagitis, right-sided diverticulitis and omental infarction.
Acute appendicitis occurring within a large right-sided inguinal hernia. There are associated rim-enhancing fluid loculations within the hernia with the largest collection measuring 9.2 x 8.7 x 4.5 cm. These findings are concerning for perforation and abscess formation. Inflammatory changes extend into the abdomen in the right paracolic region. There is no evidence of free air.
Diffuse small bowel dilatation which may represent reactive ileus in the setting of appendicitis.
Mild diffuse colonic wall thickening.
Ancillary findings:
moderate prostatomegaly
urinary bladder wall thickening
small hiatal hernia. Oesophagus is mildly distended with air and fluid and has wall thickening
mild cardiomegaly and moderate coronary artery calcification
trace right-sided pleural effusion
peripherally enhancing 9 mm lesion in the right hepatic dome, possibly representing a haemangioma