Accuracy of Nonfocused Helical CT for the Diagnosis of Acute Appendicitis: A 5-Year Review

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Accuracy of Nonfocused Helical CT for the Diagnosis of Acute Appendicitis: A 5-Year Review

Steven S. Raman¹, David S. K. Lu¹, Barbara M. Kadell¹, Darko J. Vodopich¹, James Sayre¹ and Henry Cryer²

^¹ Department of Radiology, UCLA Center for the Health Sciences, 10833 Le Conte Ave., Los Angeles, CA 90095-1721.
^² Department of Surgery, UCLA Center for the Health Sciences, Los Angeles, CA 90095-1721.

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Fig. 1. —True-positive interpretation in 27-year-old man with right lower quadrant pain. Axial contrast-enhanced helical CT scan shows that thickened appendix (>6 mm in width) and periappendiceal stranding (arrow) are present. Terminal ileum is well opacified. Secondary findings include appendiceal mural enhancement and cecal thickening.

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Fig. 2. —False-positive interpretation in 20-year-old man with right lower quadrant pain. On axial contrast-enhanced helical CT scan, thickened appendix and mild adjacent stranding (arrow) are present. Patient's symptoms resolved after medical therapy, and he was discharged.

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Fig. 3. —False-positive interpretation in 71-year-old man with right lower quadrant pain. On axial contrast-enhanced helical CT scan, we misinterpreted cecal diverticulum (arrow) as thickened appendix. Cecal diverticultis was confirmed at surgery.

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Fig. 4. —False-positive interpretation in 42-year-old man with right lower quadrant pain and surgically confirmed right-sided diverticulitis. Axial contrast-enhanced helical CT scan reveals focal region of stranding (arrow) adjacent to ascending colon. Appendix was not visualized, and acute appendicitis was included in differential diagnosis along with right-sided diverticulitis.

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Fig. 5. —False-negative interpretation in 34-year-old woman with lower abdominal pain. On axial contrast-enhanced CT scan, appendix (arrow) is at upper limits of normal range in size without periappendiceal infiltration. Appendix was not identified prospectively, and study was interpreted as showing no evidence for appendicitis.

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Fig. 6. —False-negative interpretation in 21-year-old woman with lower abdominal pain. On axial contrast-enhanced CT scan, appendix (arrow), which was identified only retrospectively, is at upper limits of normal range in thickness with minimal periappendiceal fat stranding. This study was initially interpreted as showing no evidence for appendicitis. Acute appendicitis was confirmed at pathology.

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Fig. 7. —False-negative interpretation in 89-year-old woman with right lower quadrant pain. On axial contrast-enhanced CT scan, numerous asymmetrically dilated small-bowel loops are visible. Terminal ileum and cecum are poorly filled with contrast material. Periappendiceal abscess (arrows) was present but misinterpreted as base of unopacified cecum.

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Fig. 8. —True-negative interpretation in 68-year-old woman with lower abdominal pain. On helical CT scan obtained using IV and oral contrast media, well-defined filling defect (arrow) is present in ileum. Lesion was confirmed on subsequent small-bowel barium examination. High-grade focal B-cell lymphoma was diagnosed at surgery.

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Fig. 9. —True-negative interpretation in 28-year-old woman with lower abdominal pain and fever. On contrast-enhanced CT scan, patchy enhancement is visible bilaterally. Differential diagnosis included pyelonephritis, which was confirmed clinically.

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