Radiology Resident Case of the Week
Clinical Findings consist most often of the following : fever (56%),
nausea and vomiting (40%), Right lower quadrant pain-McBurney sign (72%), leukocytosis (88%)
Etiology/Pathophysiology:
Impaction of an appendicolith, with consequencial obstruction of the outflow of the appendix and inflammation of the wall.
obstruction of lumen by lymphoid hyperplasia(60%)
fecolith(33%), foreign body (4%), stricture, tumor, parasite and crohn's stricture are also causes of obstruction.
Pathology:
There was found to be evidence of acute appendicitis, focal regions of hyalinizing granuloma and no perferation.
Miscellaneous:
Imaging:
Ultra Sound findings: -77-94% sensitive, and 90% specific, non diagnostic study in about 4% of individuals with RLQ pain secondary to inadequate compression.
- visualization of a noncompressible appendix, as a blind ending tubular aperistaltic structure(seen in 2% of normal adults, and 50% of normal children)
- target appearance, the diameter on cross section should measure >6mm.
- localization of periappendiceal fluid collection.
-lumen may be distended with anechoic or hyperechoic material, an appendicolith is seen in approximately 6% of cases.
DDx:
In a 19 year old male the differential diagnosis for right lower quadrant pain is rather limited. Acute appendicitis would be most likely diagnosis.
Key references:
Dahnert, Third Edition
ACR Code:
Keywords:
appendicitis, appendicolith