Helical CT Evaluation of Acute Right Lower Quadrant Pain: Part II, Uncommon 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., Third Floor, PO Box 980615, Richmond, VA
23298-0615.
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Fig. 1. —23-year-old woman with right lower quadrant pain. Axial CT
scan shows dilatation of distal appendix (solid arrows) with normal
caliber of proximal appendix (open arrow). No periappendiceal fat
stranding is noted. Mucocele of appendix with early rupture was found
surgically.
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Fig. 2A. —47-year-old woman with fever and right lower quadrant pain.
Axial CT scan shows enlarged, nonenhancing, thrombosed right ovarian vein
(arrows) with fat stranding (open arrows) in right lower
quadrant adjacent to normal appendix (A).
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Fig. 2B. —47-year-old woman with fever and right lower quadrant pain.
Axial CT scan obtained superior to A shows enlarged right ovarian vein
(arrows) draining into inferior vena cava (IVC).
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Fig. 3. —51-year-old woman with acute abdominal pain. Axial CT scan
shows large left adnexal mass that contains calcification and fat density
(open arrows). Fat-fluid level is seen in right anterior pelvis
(solid arrow). There is moderate amount of pelvic free fluid (F).
Surgery confirmed diagnosis of rupture of left ovarian dermoid.
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Fig. 4A. —41-year-old woman with acute right lower quadrant (RLQ) pain
and clinically suspected acute appendicitis. Axial CT scan shows large
necrotic leiomyoma (arrows) arising from right side of uterus (U).
Minimal fat stranding is noted in RLQ adjacent to leiomyoma.
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Fig. 4B. —41-year-old woman with acute right lower quadrant (RLQ) pain
and clinically suspected acute appendicitis. Axial CT scan obtained superior
to A shows tip of appendix filled with air (arrow) lateral to
inferior vena cava.
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Fig. 5A. —28-year-old woman with sudden-onset right lower quadrant
(RLQ) pain. Axial CT scan shows fat stranding (arrows) predominating
in RLQ posterior to cecum (C) and appendix (A) and heterogeneous mass in upper
pelvis representing enlarged ovary (O).
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Fig. 5B. —28-year-old woman with sudden-onset right lower quadrant
(RLQ) pain. Axial CT scan obtained inferior to A shows that torsed
ovary (O) contains cyst (asterisk). Fluid in RLQ (arrows) is
noted. Emergent surgery confirmed diagnosis of right ovarian torsion.
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Fig. 6A. —39-year-old woman with acute right lower quadrant pain. Axial
CT scan shows minimal wall thickening of terminal ileum (asterisks)
entering cecum (C).
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Fig. 6B. —39-year-old woman with acute right lower quadrant pain. Axial
CT scan obtained inferior to A shows fat stranding (arrows)
medial to cecum (C). Mildly thickened terminal ileum (asterisk) is
identified lateral to uterus (U). On basis of CT findings, diagnosis of acute
appendicitis was raised, although appendix was not detected. Normal appendix
and endometriosis of terminal ileum were detected at surgery.
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Fig. 7. —37-year-old woman with acute abdominal pain and clinical
suspicion of perforated appendicitis. Axial CT scan shows fluid collection in
right lower quadrant with attenuation of 77 H, consistent with blood
(arrows). High-attenuation foci (arrowheads) are located to
right of the uterus (U), indicative of active bleeding. Rupture of ectopic
pregnancy in right fallopian tube was confirmed surgically.
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Fig. 8. —74-year-old man with acute leukemia presenting with right
lower quadrant pain and fever. Axial CT scan shows findings of typhlitis with
marked circumferential thickening (double arrow) of cecal wall (C)
and pericecal fat stranding (arrows). Mildly thickened terminal ileum
is noted (asterisk).
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Fig. 9A. —43-year-old woman with perforated sigmoid diverticulitis
extending into right lower quadrant (RLQ). Axial CT scan shows normal distal
appendix (solid arrow) and abscess (open arrow) lateral to
appendix.
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Fig. 9B. —43-year-old woman with perforated sigmoid diverticulitis
extending into right lower quadrant (RLQ). Axial CT scan obtained inferior to
A shows abscess in RLQ (arrows).
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Fig. 9C. —43-year-old woman with perforated sigmoid diverticulitis
extending into right lower quadrant (RLQ). Delayed axial CT scan obtained
inferior to B shows thickened sigmoid colon (S) with fistula (open
arrows) that extends from sigmoid colon (S) to abscess, which contains
air and contrast material (solid arrows).
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Fig. 10. —40-year-old man with acute right lower quadrant pain. Axial
CT scan shows fat (asterisks) and soft-tissue mass (M) within loop of
right colon with thickened wall (open arrows). Fat stranding
(solid arrows) is noted surrounding this loop of bowel. Surgery
confirmed colocolic intussusception with bowel ischemia and found that lead
point was Burkitt lymphoma.
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Fig. 11A. —68-year-old woman with abdominal pain and fever who was
treated with antibiotics for 2 weeks. Axial CT scan shows thickened right and
left colon (open arrows) consistent with pseudomembranous colitis in
this clinical setting. Slightly enlarged appendix with mild wall enhancement
and periappendiceal stranding is noted (solid arrows). Coincident
acute appendicitis cannot be excluded on basis of imaging findings.
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Fig. 11B. —68-year-old woman with abdominal pain and fever who was
treated with antibiotics for 2 weeks. Repeat axial CT scan obtained 2 days
after A shows appendix filled with oral contrast material (solid
arrows). Diagnosis of appendicitis is excluded, although medial aspect of
appendix wall is thickened (arrowhead), which is result of adjacent
inflammation. Open arrows indicate thickened right and left colon.
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Fig. 12. —32-year-old man with cytomegalovirus colitis and history of
AIDS. Axial CT scan shows marked thickening of cecum (arrows).
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Fig. 13A. —37-year-old man with perforation of peptic ulcer in duodenal
bulb. Axial CT scan shows fluid collection (arrows) posterior to
cecum (C) and partially surrounding appendix (A).
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Fig. 13B. —37-year-old man with perforation of peptic ulcer in duodenal
bulb. Axial CT scan obtained superior to A shows oral contrast material
extravasation in perihepatic space (arrows), which leaked from
perforated duodenum (D).
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Fig. 14A. —55-year-old woman with right lower quadrant pain. Axial CT
scan shows fat stranding (arrows) medial to cecum (C).
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Fig. 14B. —55-year-old woman with right lower quadrant pain. Axial CT
scan obtained superior to A shows gas (arrowheads) and fat
stranding (arrows) surrounding gallbladder (GB), consistent with
emphysematous cholecystitis with perforation.
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Fig. 15A. —45-year-old man with acute pancreatitis and right abdominal
pain. Axial CT scan shows fat stranding and fluid (arrows) in right
lower quadrant adjacent to appendix (A).
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Fig. 15B. —45-year-old man with acute pancreatitis and right abdominal
pain. Axial CT scan obtained superior to A shows fat stranding
(arrows) surrounding pancreas (P).
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Copyright © 2005 by the American Roentgen Ray Society.
