What are some common finding of appendicitis on CT?
Dilated appendix with distended lumen (>6mm diameter), thickened and enhancing wall, thickening of the caecal apex (up to 80%): caecal bar sign, arrowhead sign, periappendiceal inflammation (including stranding of the adjacent fat and thickening of the lateral conal fascia or mesoappendix etc.)
Where are some common locations of the tip of the appendix?
Behind the caecum (ascending retrocaecal): 65%, inferior to the caecum (subcaecal): 31%, behind the caecum (transverse retrocaecal): 2%, anterior to the ileum (ascending paracaecal preileal): 1%, posterior to the ileum (ascending paracaecal retroileal): 0.5%.
What are some potential complications of appendicitis?
Complications include: perforation occurs in up to 13-30% of cases: appendiceal abscess, generalized peritonitis, pylephlebitis: infective thrombophlebitis of the portal circulation with possible hepatic abscess.
The appendix is abnormally distended to 10 mm and demonstrates mural thickening with surrounding stranding in keeping with acute appendicitis.
Prominent regional ileocolic lymph nodes are identified, measuring up to 9 x 7 mm.
With the exception of the mild stranding around the appendix, there is no free intraperitoneal fluid. No pneumoperitoneum.
No discrete collection.
In segment IV of the liver, there is a 16 x 10 mm low density lesion above the level of the falciform ligament. This probably represents an area of focal fatty change but could be further assessed with an ultrasound.
Otherwise the liver, spleen, adrenals, kidneys and pancreas are normal.
The lung bases are clear.
Conclusion:
Acute appendicitis.