Irregular mass-like enhancement of the caecum with abnormal wall thickening causing obstruction of the appendiceal orifice. The appendix is dilated and fluid-filled measuring 19 mm in maximal diameter. The appendix extends from the caecum inferiorly and courses across the midline to the left. The appendiceal tip demonstrates decreased mural enhancement. Significant mesenteric stranding is seen throughout the right iliac fossa with a small volume of free fluid tracking into the pelvis. The adjacent terminal ileum demonstrates mural oedema and fecalisation of contents proximally.
Enlarged right lower mesenteric lymph nodes. Some of these are mildly hyperdense and show contrast enhancement. Diffuse small para-aortic and retrocrural lymph nodes.
Dependent calcified gallbladder sludge within the gallbladder fundus. No CT features of cholecystitis. The liver, spleen, pancreas, and adrenal glands are normal. Small bilateral midpolar renal cysts.
Small enostoses in the left inferior ileum adjacent to the left sacroiliac joint. No concerning osseous lesion identified. Mild dependent hypostatic changes in the lung bases bilaterally.
Impression
caecal mass causing appendiceal obstruction. Reduced enhancement of the appendiceal tip is suspicious for necrosis. No features of perforation at this stage. The caecal mass is cancer until proven otherwise. Surgical opinion is advised
terminal ileitis with small bowel faeces sign which indicates slow transit, which could be secondary to inflammatory change or partial ileal obstruction from the caecal mass
multiple enlarged right mesenteric lymph nodes are larger than expected for simple inflammation of the appendix and are suspicious for neoplastic involvement. Given some of these are hyperdense, DDx should include neuroendocrine neoplastic disease of the caecum