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The Nonvisualized Appendix: Incidence of Acute Appendicitis When Secondary Inflammatory Changes Are Absent

Paul Nikolaidis1, Caroline M. Hwang1, Frank H. Miller1 and Nicholas Papanicolaou2

1 Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N St. Clair St., Ste. 800, Chicago, IL 60611.
2 Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA.



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  		Fig. 1A. —Contrast-enhanced MDCT scans illustrate pericecal fat scores of 0, 1, and 2, respectively. Image of 22-year-old man with nonvisualized appendix shows paucity of pericecal fat. Score of 0 was assigned because fat outlined less than half of cecum and rim of fat surrounding cecum is less than 1.0 cm.

 


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  		Fig. 1B. —Contrast-enhanced MDCT scans illustrate pericecal fat scores of 0, 1, and 2, respectively. Image of 36-year-old woman with nonvisualized appendix shows fat outlined more than half of entire circumference of cecum and rim of fat surrounding cecum was less than 1.0 cm; therefore, score of 1 was assigned.

 


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  		Fig. 1C. —Contrast-enhanced MDCT scans illustrate pericecal fat scores of 0, 1, and 2, respectively. Image of 49-year-old woman with nonvisualized appendix shows ample pericecal fat; score of 2 was assigned.

 


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  		Fig. 2A. —23-year-old woman who presented to emergency department with acute right lower quadrant pain. On contrast-enhanced MDCT scans, appendix is not visualized. Patient has paucity of pericecal fat, so score of 0 was assigned. Oral contrast material did not reach region of cecum in this patient. She underwent surgery on the basis of high clinical suspicion for acute appendicitis, which was confirmed by intraoperative findings and surgical pathology.

 


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  		Fig. 2B. —23-year-old woman who presented to emergency department with acute right lower quadrant pain. On contrast-enhanced MDCT scans, appendix is not visualized. Patient has paucity of pericecal fat, so score of 0 was assigned. Oral contrast material did not reach region of cecum in this patient. She underwent surgery on the basis of high clinical suspicion for acute appendicitis, which was confirmed by intraoperative findings and surgical pathology.

 

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