Presentation
Fever, nausea and vomiting. Diffuse abdominal pain.
Patient Data
The appendix is diffusely enlarged (measuring 2 cm in diameter) with thickened walls. There is periappendiceal inflammation, including stranding of the adjacent fat and minimal extraluminal fluid. Two small calcifications within the appendix base may correspond to appendicoliths. There is also diffuse hepatic steatosis. The remainder of the exam is unremarkable.
Case Discussion
This case shows an exuberant acute appendicitis case in which almost all of the radiological signs are present and clearly identified. In older patients with abundant intra-abdominal fat between bowel loops, diagnosing acute appendicitis is often not difficult. Early presentation in skinny patients, teenagers or even kids can add some difficulty in spotting an inflammed appendix.
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