Appendicitis

Pathophysiology

• Obstruction of lumen causes diffuse pain

• Intraluminal bacterial overgrowth causes:– Mucosal breakdown– Bacterial invasion of appendiceal wall– Inflammation --> peritonitis --> localized pain

– Perforation• E. coli, Peptostreptococcus• B. fragilis, Pseudomonas

Technique

• IV contrast - 2cc/kg– Enhances inflammatory processes

• Helical (spiral) multidetector technique

• May use oral and/or rectal contrast

Enlarged Appendix

• Enlarged appendix

(> 6mm diameter)

Enlarged Appendix

• Enlarged appendix

(> 6mm diameter) 12mm

Appendiceal Wall Thickening

• Enlarged appendix

(> 6mm diameter)

• Appendiceal wall thickening (>2mm)

Appendiceal Wall Thickening

• Enlarged appendix

(> 6mm diameter)

• Appendiceal wall thickening (>2mm)

Wall Enhancement

• Enlarged appendix

(> 6mm diameter)

• Appendiceal wall thickening (>2mm)

• Appendiceal wall enhancement

Wall Enhancement

• Enlarged appendix

(> 6mm diameter)

• Appendiceal wall thickening (>2mm)

• Appendiceal wall enhancement

Fat Stranding

• Enlarged appendix (> 6mm diameter)

• Appendiceal wall thickening (>2mm)

• Appendiceal wall enhancement

• Periappendiceal fat stranding

Fat Stranding

• Enlarged appendix (> 6mm diameter)

• Appendiceal wall thickening (>2mm)

• Appendiceal wall enhancement

• Periappendiceal fat stranding

Appendicolith

• Seen in 20-40% of patients

Appendicolith

• Seen in 20-40% of patients

Target Structure

• Concentric thickening of the inflamed appendiceal wall

Target Structure

• Concentric thickening of the inflamed appendiceal wall

Intraluminal Air

Case Review

• Case 12 - 10 year old male with RLQ pain

• Case 15 - 8 year old male with RLQ pain• Case 26 - 10 year old male with RLQ pain

• Case 27 - 12 year old male with RLQ pain

• Case 43 - 5 year old male with RLQ pain• Case 65 - 8 year old male with RLQ pain