MyPACS.net: Radiology Teaching Files > Case 32632086

previously visited APPENDICULAR ABSCESS
Contributed by: dalia yosif, Radiologist, Kasr Aini hospital, Egypt.
Patient: 49 year old female
History: 49 year old female: ,presented to ER  complaining of severe right iliac pain,she had fever & tachycardia & marked tenderness at the right iliac  region; ultrasound examination revealed anechoic cystic  lesion with strong acoustic enhancement measuring  about 5.2x2.2 cm at the right iliac region very close to the anterior abdominal wall with the adjacent cecal  &pericecal region showing markedly increased echogenicity (thyroid in the belly sign )(asign of inflammation)
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Findings:

CT exam of the abdomen & pelvis without contrast revealed:

NB :this patient had previous CT with oral contrast ,so the colon is seen enhanced

cystic lesion with air fluid level is seen near the anterior abdominal wall(abscess),

fat stranding in the periappendiceal region,marked ileocecal thickening, localized lymphadenopathy are also noted,

The patient was managed consevatively with (antibiotics only) for 3 days with no improvement so needle aspiration for the abscess was made , 'm still waiting for more for this patient.....

 

Diagnosis: appendicular abscess
Discussion:

CT scan findings in appendicitis:

Specific CT scan findings of appendicitis include enlargement of the appendix (>6 mm in the outer diameter), enhancement of the appendiceal wall, lack of opacification in an enlarged appendix, fat stranding in the periappendiceal region, and the presence of an appendicolith within the appendix . The appendicolith may be observed outside the appendix lumen within an inflammatory mass or in a fluid collection,

A few secondary findings often accompany acute appendicitis. Focal thickening of the cecum may occur. The inflammatory process can be observed to separate the cecal lumen from the base of the appendix or an appendicolith (cecal bar). Contrast medium is observed within the cecum channeling to the point of the appendiceal obstruction (arrowhead sign),

Gangrenous appendicitis is recognized as enlargement of the appendix with associated fluid and loculated air within the lumen

Distal appendicitis is diagnosed when CT scanning reveals appendicitis that involves the distal appendix, with a normal-appearing proximal appendix

Detection of phlegmons, abscesses, and RLQ inflammation adjacent to the cecum is strongly suggestive of—but not pathognomonic for—acute appendicitis. Perforated appendicitis is usually accompanied by pericecal phlegmon or abscess formation. Free intra-abdominal air can be observed either under the right diaphragm or in a retroperitoneal location in patients with a perforated appendix. Associated CT scan findings include extraluminal air, marked ileocecal thickening, localized lymphadenopathy, peritonitis, and small-bowel obstruction

False Positives/Negatives

Some CT scan findings that are suggestive of or often accompany acute appendicitis are nonspecific and can be observed with other RLQ conditions, such as Crohn disease , ulcerative colitis, pancreatitis , perforation of a duodenal ulcer, and cholecystitis. Misinterpretation of these signs as indicative of appendicitis can lead to a false-positive result

Conversely, specific signs can be misapplied. Without optimal cecal opacification, a distended, inflamed appendix can be mistaken for a small-bowel loop. Rarely, an appendiceal lumen filled with appendicoliths can mimic an opacified lumen on CT scans.

Distal appendicitis can potentially be the cause of a false-negative interpretation.

References: emedicine
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Additional Details:

Case Number: 32632086Last Updated: 11-13-2009
Anatomy: Gastrointestinal (GI)   Pathology: Infection
Modality: CT, GIAccess Level: Readable by all users

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