Presentation
Right iliac fossa pain.
Patient Data
The appendix is dilated to 11 mm with its tip lying within the retrocecal space. The wall is thickened and there is surrounding fat stranding as well as thickening of the adjacent parietal peritoneum. There is soft tissue thickening at the base of the appendix consistent with positive cecal bar sign. No appendicolith identified. No periappendiceal collection. The remainder of the large bowel is all small bowel are unremarkable. No free intra-abdominal gas of fluid collections.
There is diffuse hepatic steatosis with no focal liver lesion identified. The gallbladder, pancreas and adrenal glands have an unremarkable appearance. There is a 20 mm rounded hypodensity within the interpolar region of the right kidney that likely represents a renal cyst. The remainder of the kidneys are unremarkable. Within the spleen, there is a 5 mm hypodensity that is too small to characterize on CT. The portal vein opacifies normally.
No enlarged intra-abdominal or pelvic lymphadenopathy.
Conclusion:
Appendicitis (retrocecal).
Case Discussion
The base of the appendix is separated from the contrast-filled cecum by inflammatory soft tissue, known as cecal bar sign, a secondary sign in acute appendicitis.
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