MyPACS.net: Radiology Teaching Files > Case 35089541

never visited APPENDICEAL MASS
Contributed by: Sheldon Jensen, Resident, Brooke Army Medical Center, Texas, USA.
Patient: male
History: Middle aged male presents to ED with right lower quadrant pain and vomiting.
Images:[small]larger

Fig. 1: thickened wall of proximal appendix connected to suspected abscess

Fig. 2: stranding, hypoattenuating wall, air-fluid level adjacent to appendix

Fig. 3: appendicolith inside suspected abscess with air-fluid level

Fig. 4: stranding, thickened appendiceal tail from suspected abscess

Fig. 5: IR consulted to put in percutaneous drain

Fig. 6: gross image of appendiceal mass

Fig. 7: gross bisected mass off appendix
Findings:

Stranding and hypoattenuating mass with central air-fluid level and appendicolith connected to appendix, felt to represent abscess/ruptured appendicitis.

IR consulted to place percutaneous catheter in to drain abscess.  Catheter placed successfuly, but minimal fluid removed.

Patient taken to surgery.  Intraoperative findings of appendiceal mass.

Diagnosis:

1. Appendicitis

2. Appendiceal mass.  Path pending.

Discussion:

Classic carcinoid tumors of the appendix derive from subepithelial neuroendocrine cells and may represent up to 80% of all appendiceal neoplasms (2,16). Unlike with most other primary appendiceal neoplasms, its discovery at surgery or pathologic examination is most often serendipitous.  Even in the setting of acute appendicitis, a coexisting carcinoid tumor is the obstructing cause in only 25% of cases, reflecting the fact that over 70% are found in the distal third of the appendix (away from the base) and are less than 1 cm in size (2,17).

References: Primary Neoplasm of the Appendix:  Radiologic Spectrum of Disease with Pathologic Correlation, Radiographics, May-June 2003, Volume 23, Number 3
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Additional Details:

Case Number: 35089541Last Updated: 01-07-2010
Anatomy: Gastrointestinal (GI)   Pathology: Neoplasm
Modality: CT, GIAccess Level: Readable by all users
Keywords: appendix

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