Presentation
Classical symptoms of acute appendicitis. Surgeon wishes for a CT.
Patient Data
Dilated thick walled fluid filled appendix containing four calcified appendicoliths.
One lies at the ostium resulting in obstruction.
No free fluid, free gas or collection.
Annotations indicate the; dilated, thick walled and fluid filled appendix, containing four calcified appendicoliths.
Case Discussion
Acute appendicitis is largely a clinical diagnosis with the use of imaging reserved for complicated cases or the elderly with concern over an underlying colorectal malignancy.
Ultrasound remains the first line investigation given the typically young patient demographics for the condition and in females the importance of gynecological pathology in the differential diagnoses.
Clinicians and radiologists have a duty to use radiation wisely following the application of clinical acumen and interdisciplinary discussion.
The CT shows a full house of signs:
- a thick walled appendix
- a fluid filled distended appendix
- several luminal calcified appendicoliths