Presentation
Pregnant woman with right lower quadrant pain.
Patient Data
Intrauterine pregnancy at 1st trimester.
On T2W images, the position of the appendix could be identified at retrocaecal area, which measures about 5mm in diameter.
No surrounding fat stranding or focal fluid collection were noted on T2W fat sat.
MRA images could help differentiate between appendix and other normal vascular structures.
Case Discussion
The patient has right lower quadrant pain and increased serum WBC number. Her ultrasound examination could not find the appendix due to its position posterior to the caecum and ascending colon. Therefore, an abdominal MRI without contrast agent took place for further evaluation.
On MRI images, the patient's uterus and fetus are quite small because of their early stage of pregnancy; so, the ceacum and right colon are still in right position. The appendix could be easily identified at retrocaecal area, which has intermediate signal on T1W and T2W images. The normal appendix had equal signal to adjacent bowel wall. Its border is more prominent on T1W out-of-phase images due to India ink artifact.
In this case, the appendix has no signs of inflammation; however, abdominal endoscopic surgery has been done due to the patient's clinical symptoms. A normal appendix was confirmed intra-operation.
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