Presentation
Abdominal pain.
Patient Data
Blind-ending 12mm fluid-distended tubular structure arising from the posterior cecal pole extending proximally to the sub-hepatic region with marked surrounding fat stranding.
Uniformly enhancing thickened appendiceal wall with no abnormal gas and no abscess or phlegmon.
Incidental abnormal distal anterior abdominal wall.
Case Discussion
CT has high sensitivity and specificity for appendicitis and it’s complications.
Recognition of the wide range of normal appearances of the appendix will avoid unnecessary surgery. Appendicitis should never be diagnosed on size alone.
Appendicitis is usually due to luminal obstruction which results in fluid distension due to continued mucus production. The normal appendiceal wall is variable in thickness, decreasing in adulthood as lymphoid tissue diminishes. Mural inflammation causes wall-thickening and fat-stranding.
The appendix is widely variable in location and inflammation can present with peritonism anywhere in the abdomen and it’s orifices.
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