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CT Evaluation of Appendicitis and Its Complications: Imaging Techniques and Key Diagnostic Findings

¹ Department of Radiology, Hospital São João, Oporto Medical School, Oporto, Portugal.
² Deceased.
³ Present address: Department of Radiology, University of California, San Diego, 200 W Arbor Dr., San Diego, CA 92103–8756.

View larger version (132K): [in a new window]   Fig. 1 —CT scan after oral contrast administration in 32-year-old woman with normal appendix. Note normal appendix with intraluminal enteric contrast material and gas (arrows). Appendix wall is nearly imperceptibly thin.

View larger version (123K): [in a new window]   Fig. 2A —6-year-old girl with acute appendicitis. CT scans obtained before (A) and after (B) IV contrast administration illustrate benefit of IV contrast material in difficult cases. Unenhanced scan is indeterminate because appendix is not confidently visualized. Enhanced scan shows dilated appendix with thickened, hyperenhancing wall (arrows, B). Notice mural stratification of appendix wall.

View larger version (125K): [in a new window]   Fig. 2B —6-year-old girl with acute appendicitis. CT scans obtained before (A) and after (B) IV contrast administration illustrate benefit of IV contrast material in difficult cases. Unenhanced scan is indeterminate because appendix is not confidently visualized. Enhanced scan shows dilated appendix with thickened, hyperenhancing wall (arrows, B). Notice mural stratification of appendix wall.

View larger version (155K): [in a new window]   Fig. 3 —38-year-old man with early, acute appendicitis. Unenhanced CT scan shows inflamed appendix measuring 10 mm in transverse diameter (arrows). Note low-attenuation edema in submucosal layer of appendix. No appendicoliths, free air, adjacent fluid collection, or fat stranding is seen. Surgery confirmed early, nonperforated appendicitis.

View larger version (157K): [in a new window]   Fig. 4 —20-year-old man with acute appendicitis. Oral and IV contrast-enhanced CT scan shows thickened, fluid-filled appendix (arrows).

View larger version (154K): [in a new window]   Fig. 5 —33-year-old man with acute appendicitis. Axial oblique reformatted image of CT study after administration of oral and IV contrast material shows distended appendix with wall enhancement (arrow) and appendicolith (arrowhead). Note periappendiceal fat stranding. Surgery confirmed perforated appendix.

View larger version (144K): [in a new window]   Fig. 6 —27-year-old woman with acute appendicitis. Axial CT image after IV and oral contrast administration shows thickened appendiceal wall, with wall enhancement (arrow) and fat stranding. Note thickening of adjacent bladder wall (arrowheads) caused by inflammatory process.

View larger version (158K): [in a new window]   Fig. 7 —32-year-old man with acute appendicitis. Unenhanced CT shows appendicolith (arrowhead), periappendiceal fat stranding (black arrows), lateral conal fascia thickening (white arrow), and periappendiceal fluid.

View larger version (144K): [in a new window]   Fig. 8 —17-year-old boy with acute appendicitis. CT with oral contrast material shows cecal apical wall thickening (arrowheads).

View larger version (139K): [in a new window]   Fig. 9 —16-year-old girl with acute appendicitis. Axial CT after oral and IV contrast material shows cecal wall thickening around appendiceal orifice. Enteric contrast material in cecal lumen points to enlarged appendix (arrow) and assumes triangular configuration (arrowhead sign [arrowhead]).

View larger version (127K): [in a new window]   Fig. 10 —47-year-old man with periappendiceal abscess. Helical CT after IV contrast injection shows periappendiceal abscess extending into psoas muscle (arrowheads).

View larger version (142K): [in a new window]   Fig. 11A —21-year-old man with mesenteric adenitis. Unenhanced axial CT shows enlarged mesenteric lymph nodes (A, arrows) and normal appendix (B, arrowhead).

View larger version (144K): [in a new window]   Fig. 11B —21-year-old man with mesenteric adenitis. Unenhanced axial CT shows enlarged mesenteric lymph nodes (A, arrows) and normal appendix (B, arrowhead).

View larger version (137K): [in a new window]   Fig. 12 —41-year-old man with cecal diverticulitis. Helical CT after oral and IV contrast administration shows diverticulum in cecum (arrow) and mild surrounding fat stranding. Note normal appendix (arrowhead) and engorged vasa recta.

View larger version (160K): [in a new window]   Fig. 13 —52-year-old woman with epiploic appendagitis. Axial IV contrast-enhanced CT shows small fat-attenuation lesion (arrowhead) adjacent to right colon with round hyperdense focus in center (arrow). Note also asymmetric thickening of adjacent colon and infiltration of mesenteric fat.

View larger version (153K): [in a new window]   Fig. 14 —30-year-old man with omental infarction. Abdominal CT shows well-circumscribed region of inflamed omental fat, with streaklike areas of inflammatory stranding (arrowheads).

View larger version (163K): [in a new window]   Fig. 15A —48-year-old woman with appendiceal mucocele. Axial (A) and coronal reformatted (B) CT scans obtained after oral and IV contrast administration show distended appendiceal lumen caused by abnormal mucus accumulation (arrows).

View larger version (169K): [in a new window]   Fig. 15B —48-year-old woman with appendiceal mucocele. Axial (A) and coronal reformatted (B) CT scans obtained after oral and IV contrast administration show distended appendiceal lumen caused by abnormal mucus accumulation (arrows).

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