Helical CT Evaluation of Acute Right Lower Quadrant Pain: Part I, Common Mimics of Appendicitis
Jinxing Yu,
Ann S. Fulcher,
Mary Ann Turner and
Robert A. Halvorsen
Department of Radiology, Virginia Commonwealth University, Medical
College of Virginia, 401 N 12th St., PO Box 980615, Main Hospital, Third
Floor, Richmond, VA 23298-0615.
View larger version (102K):
[in a new window]
|
Fig. 1A. —22-year-old man with acute appendicitis. C = cecum. Axial CT
image shows enlarged appendix (arrow) and fat stranding in right
lower quadrant (arrowheads) posterior and medial to cecum.
|
|
View larger version (102K):
[in a new window]
|
Fig. 1B. —22-year-old man with acute appendicitis. C = cecum. Axial CT
scan obtained inferior to A shows dilated appendix arising from cecum
with wall enhancement and thickening (arrows).
|
|
View larger version (135K):
[in a new window]
|
Fig. 2. —27-year-old man with right lower quadrant pain for 1 day and
low-grade fever. Axial CT image shows mildly enhanced appendix
(arrows) with diameter of 6 mm and minimal periappendiceal fatty
stranding consistent with early acute appendicitis.
|
|
View larger version (121K):
[in a new window]
|
Fig. 3A. —27-year-old man with perforated acute appendicitis. Axial CT
scan shows extensive fat stranding and fluid collection (arrows)
surrounding enhanced and dilated appendix (A). Adjacent small bowel (sb) shows
wall thickening.
|
|
View larger version (123K):
[in a new window]
|
Fig. 3B. —27-year-old man with perforated acute appendicitis. Axial CT
scan obtained inferior to A shows defect (arrowheads) in
inflamed appendiceal wall (A), indicating perforation. Extensive fat stranding
and fluid collection (arrows) are present.
|
|
View larger version (126K):
[in a new window]
|
Fig. 4. —43-year-old man with Crohn's disease. Axial CT scan shows
circumferential wall thickening of cecum (solid arrows) and terminal
ileum (open arrow).
|
|
View larger version (109K):
[in a new window]
|
Fig. 5A. —24-year-old woman with Crohn's disease and abscess. sb =
small bowel. Axial CT scan shows circumferential wall thickening of distal
small bowel and cecum (C) with adjacent fat stranding (arrow).
|
|
View larger version (109K):
[in a new window]
|
Fig. 5B. —24-year-old woman with Crohn's disease and abscess. sb =
small bowel. Axial CT scan obtained inferior to A shows large abscess
(arrows) in mesentery adjacent to long segment of distal small bowel
with wall thickening.
|
|
View larger version (137K):
[in a new window]
|
Fig. 6A. —34-year-old woman with acute right lower quadrant pain. Axial
CT scan shows dilated tubular fluid-density structure in right adnexa
(arrows) medial to cecum (C) consistent with right hydrosalpinx.
|
|
View larger version (139K):
[in a new window]
|
Fig. 6B. —34-year-old woman with acute right lower quadrant pain. Axial
CT scan obtained inferior to A shows fat stranding (open
arrows) surrounding right ovary (O). Physical examination showed vaginal
discharge and cervical motion tenderness consistent with pelvic inflammatory
disease. Uterus (U) is noted.
|
|
View larger version (121K):
[in a new window]
|
Fig. 7A. —33-year-old woman with fever and right abdominal pain. Axial
CT scan shows linear low densities with striated appearance (arrows)
in right kidney consistent with pyelonephritis.
|
|
View larger version (120K):
[in a new window]
|
Fig. 7B. —33-year-old woman with fever and right abdominal pain. Axial
CT scan obtained inferior to A shows complex fluid collection
(arrow) consistent with evolving abscess.
|
|
View larger version (123K):
[in a new window]
|
Fig. 8A. —41-year-old man with right lower quadrant (RLQ) pain. Axial
CT image shows fatty stranding in RLQ (solid arrows) surrounding
contrast-filled appendix (open arrow).
|
|
View larger version (136K):
[in a new window]
|
Fig. 8B. —41-year-old man with right lower quadrant (RLQ) pain. Axial
CT scan obtained superior to A shows dilatation of right renal
collecting system (arrows) consistent with obstruction. Final
diagnosis was right ureteropelvic obstruction.
|
|
View larger version (122K):
[in a new window]
|
Fig. 9. —28-year-old woman with acute right lower quadrant pain. Axial
CT scan shows cystic structure in right adnexa (arrows) with
well-defined wall most likely representing hemorrhagic cyst. Follow-up pelvic
sonography performed 6 weeks later (not shown) showed interval resolution of
cyst.
|
|
View larger version (123K):
[in a new window]
|
Fig. 10A. —42-year-old man with right-sided diverticulitis. Axial CT
scan shows multiple diverticula (arrowheads) of right colon (C) with
pericolonic fat stranding (arrows).
|
|
View larger version (127K):
[in a new window]
|
Fig. 10B. —42-year-old man with right-sided diverticulitis. Axial CT
scan obtained superior to A shows inflamed diverticulum
(arrowhead) in medial aspect of right colon (C) with extensive
pericolonic fat stranding (arrows).
|
|
View larger version (141K):
[in a new window]
|
Fig. 11. —23-year-old man with right lower abdominal pain. Axial CT
scan shows several slightly enlarged lymph nodes (arrows) in
mesentery, medial to right colon (C).
|
|
View larger version (143K):
[in a new window]
|
Fig. 12. —42-year-old woman with right abdominal pain. Axial CT scan
shows fat-containing lesion (asterisk) with hyperattenuating rim and
fat stranding (arrows) in right lower quadrant right lateral to cecum
(C), consistent with epiploic appendagitis.
|
|
View larger version (159K):
[in a new window]
|
Fig. 13. —58-year-old man with acute right lower quadrant pain. Axial
CT scan shows wall thickening of cecum (C) with pneumatosis (open
arrows) and pericecal fat stranding (solid arrows). Loops of
small bowel (S) are dilated, consistent with ileus. Surgery confirmed
infarction of cecum.
|
|
View larger version (132K):
[in a new window]
|
Fig. 14A. —59-year-old woman with fever and acute right abdominal pain.
Axial CT image shows mass in right abdomen, containing gas and fluid with
adjacent fatty stranding (solid arrows) consistent with abscess.
Right renal hemorrhagic cyst (open arrows) was noted and confirmed on
follow-up sonography (not shown).
|
|
View larger version (132K):
[in a new window]
|
Fig. 14B. —59-year-old woman with fever and acute right abdominal pain.
Axial CT image obtained 1 cm inferior to A shows marked wall thickening
of short segment of right colon (arrows). Right colonic carcinoma
with perforation was confirmed surgically.
|
|
View larger version (141K):
[in a new window]
|
Fig. 15. —45-year-old man with Salmonella ileocolitis. Axial
CT scan shows thickened cecum (C) and terminal ileum (arrows), with
latter mimicking abnormal appendix.
|
|
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
Copyright © 2005 by the American Roentgen Ray Society.
