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Inverted Appendiceal Stumps Simulating Large Pedunculated Polyps on Screening CT Colonography

Tyler M. Prout1, Andrew J. Taylor1 and Perry J. Pickhardt1

1 All authors: Department of Radiology, University of Wisconsin Medical School, E3/311 Clinical Science Center, 600 Highland Ave., Madison, WI 53792-3252.


Figure 1
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  		Fig. 1A —Inverted appendiceal stump in 63-year-old asymptomatic woman referred to CT colonography (CTC) for routine colorectal cancer screening. Three-dimensional endoluminal view from prone CTC data set shows discrete 10-mm pedunculated polypoid lesion located at medial aspect of cecal tip.

 

Figure 2
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  		Fig. 1B —Inverted appendiceal stump in 63-year-old asymptomatic woman referred to CT colonography (CTC) for routine colorectal cancer screening. Prone transverse (B) and coronal (C) 2D images from CTC confirm pedunculated lesion (arrow) detected on 3D view and show its soft-tissue composition. Lesion is located at or near appendectomy site, but this does not completely exclude possibility of neoplasm.

 

Figure 3
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  		Fig. 1C —Inverted appendiceal stump in 63-year-old asymptomatic woman referred to CT colonography (CTC) for routine colorectal cancer screening. Prone transverse (B) and coronal (C) 2D images from CTC confirm pedunculated lesion (arrow) detected on 3D view and show its soft-tissue composition. Lesion is located at or near appendectomy site, but this does not completely exclude possibility of neoplasm.

 

Figure 4
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  		Fig. 1D —Inverted appendiceal stump in 63-year-old asymptomatic woman referred to CT colonography (CTC) for routine colorectal cancer screening. Digital photograph from optical colonoscopy performed same day as CTC shows same cecal lesion. Given endoscopic appearance, an inverted appendiceal stump was favored, which was further supported by biopsies that were negative for neoplasm.

 

Figure 5
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  		Fig. 2A —Inverted appendiceal stump in 58-year-old asymptomatic woman referred for screening CT colonography (CTC). Three-dimensional endoluminal view from CTC shows a large pedunculated cecal polyp arising near expected location of appendiceal orifice.

 

Figure 6
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  		Fig. 2B —Inverted appendiceal stump in 58-year-old asymptomatic woman referred for screening CT colonography (CTC). Transverse 2D image with soft-tissue window settings shows a punctate focus of apparent fat attenuation within polyp head (arrow). Although low-dose technique precluded confident exclusion of an adenomatous polyp based on this finding, possibility of inverted appendiceal stump was suggested.

 

Figure 7
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  		Fig. 2C —Inverted appendiceal stump in 58-year-old asymptomatic woman referred for screening CT colonography (CTC). Digital photograph from optical colonoscopy performed same day as CTC shows same cecal lesion, which was thought to represent a true polyp and removed by snare with cautery. Inverted appendiceal stump was confirmed at pathologic evaluation.

 

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