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Incidence of Acute Appendicitis in Patients with Equivocal CT Findings

¹ Department of Radiology, Rm. B1D502G, University of Michigan Medical Center, 1500 E Medical Center Dr., Ann Arbor, MI 48109-0030.
² Department of Biostatistics, University of Michigan Medical Center, Ann Arbor, MI 48109-0030.

View larger version (10K): [in a new window]   Fig. 1. —Bar graph shows number of CT examinations performed for appendicitis during each year of study in men (black) and in women (gray).

View larger version (20K): [in a new window]   Fig. 2. —Bar graph shows initial percentage of negative (top), positive (middle), and equivocal (bottom) CT examinations for appendicitis (n = 1,344) by year.

View larger version (111K): [in a new window]   Fig. 3A. —Isolated appendiceal enlargement. 24-year-old woman with right lower quadrant and flank pain and elevated WBC has 7- to-8-mm-diameter appendix (arrow). Patient was subsequently determined to have pyelonephritis.

View larger version (102K): [in a new window]   Fig. 3B. —Isolated appendiceal enlargement. 22-year-old woman with right lower quadrant pain and elevated WBC has 10-mm-diameter appendix (arrow). She was subsequently found to have appendicitis at surgery.

View larger version (96K): [in a new window]   Fig. 4A. —Right lower quadrant stranding or fluid and normal-caliber appendix. 44-year-old man with abdominal pain has large right lower quadrant inflammatory mass (arrow, A). Appendix (arrowhead, B) is gas-filled and normal in size. Follow-up CT 1 month later confirmed improving omental infarction.

View larger version (90K): [in a new window]   Fig. 4B. —Right lower quadrant stranding or fluid and normal-caliber appendix. 44-year-old man with abdominal pain has large right lower quadrant inflammatory mass (arrow, A). Appendix (arrowhead, B) is gas-filled and normal in size. Follow-up CT 1 month later confirmed improving omental infarction.

View larger version (129K): [in a new window]   Fig. 4C. —Right lower quadrant stranding or fluid and normal-caliber appendix. 60-year-old woman presented with right lower quadrant pain, fever, and leukocytosis. CT scan showed thickening of cecum and ascending colon (arrow, C). Appendix (arrowhead, D) is gas-filled and normal in caliber. Patient was shown to have cecal infarction at surgery.

View larger version (130K): [in a new window]   Fig. 4D. —Right lower quadrant stranding or fluid and normal-caliber appendix. 60-year-old woman presented with right lower quadrant pain, fever, and leukocytosis. CT scan showed thickening of cecum and ascending colon (arrow, C). Appendix (arrowhead, D) is gas-filled and normal in caliber. Patient was shown to have cecal infarction at surgery.

View larger version (130K): [in a new window]   Fig. 5. —Right lower quadrant stranding or fluid without visualized appendix. In 40-year-old woman who presented with bilateral lower quadrant pain, large inflammatory mass (arrow) is noted in right lower quadrant. Appendix is not visualized. Appendicitis was found at surgery.

View larger version (102K): [in a new window]   Fig. 6A. —False-negative initial interpretations. 40-year-old woman with right lower quadrant pain underwent contrast-enhanced CT originally erroneously interpreted as negative. On retrospective review, enlarged, thickened appendix (arrow) with adjacent stranding was identified by both reviewers, who correctly diagnosed appendicitis.

View larger version (96K): [in a new window]   Fig. 6B. —False-negative initial interpretations. 18-year-old woman with right lower quadrant pain underwent contrast-enhanced CT, which was originally interpreted as negative. Long tubular appendix (arrow) anterior to cecum with minimal adjacent stranding was correctly identified by only one of two retrospective reviewers.

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