Hi i’m doctor andrew dixon from radiopaedia.org and in this video we’re going to look at some of the CT features of
acute appendicitis and we’re going to do it by looking at
axial and coronal images from a case of a 60-year-old male presenting with
right sided abdominal pain we’re going to begin by looking at the coronal images
and you can see here in the right iliac fossa that there is a blind ending tubular structure and as we follow it back we can see that
it arises from the base of the caecum consistent with it being the appendix. when we switch to the axial plane we
can see that the appendix is abnormally distended measuring greater than six
millimeters in diameter and the fat surrounding the appendix is abnormal.
instead of appearing nice and black the fat is oedematous and has turned gray, an appearance known as fat stranding. we can compare that to region of normal intra-abdominal fat here which has a
nice black appearance. We can also see that there is a linear structure
coming off the appendix which is an inflamed meso-appendix
which is often seen in the setting of appendicitis. This patient also has reactive enlargement of their mesenteric lymph nodes which is another common finding in acute
appendicitis. importantly our patient does not have
evidence of an abscess or any locules of free gas to suggest perforation. Here’s a different patient showing an abscess adjacent to the tip of an inflamed appendix. This patient also has a calcified appendicolith at the base of the appendix causing the obstruction. this is a common finding in appendicitis
but is certainly not present in every case This patient also has an unrelated but
it’s very important pathology demonstrated on these images. Here in the left renal upper pole there is a heterogenous mass which is quite a large and is invading beyond
Gerota’s fascia and probably getting into the left adrenal gland.
This appearance is consistent with a real cell carcinoma which was an incidental
finding his patient but obviously a very important one. So there you have it some CT features of
acute appendicitis. Blind-ending, tubular structure in the
right iliac fossa, arising from the base of the caecum with thickening greater than six millimeters and surrounding inflammatory fact change. you can find out more about acute
appendicitis on the radiopaedia.org website.