"in patients over 40 presenting with complicated appendicitis (abscess or phlegmon), an underlying appendiceal neoplasm should be considered; reported rates of occult malignancy in this group range from 2.3% to 12% — CT findings that warrant mention in the report include an appendiceal diameter >14 mm, nodular or asymmetric wall thickening, and a soft tissue mass at the appendiceal base, as these may prompt colonoscopy or interval appendicectomy 43,44"
"rebound tenderness over the appendix (e.g. RIF: McBurney sign)"
"APPEND score"
"AIR score"
"Appendicitis is frequently caused by obstruction of the appendiceal lumen. The appendix continues to secrete mucus which raises intraluminal pressure causing ischaemia, initially antimesenteric, and subsequent gangrene and perforation. Stasis also causes bacterial overgrowth and gas formation. The biofilm and glycocalyx are penetrated allowing bacterial invasion. Omental fat migrates to the RIF surrounding the inflamed appendix and a phlegmon, an abscess or free purulent fluid may be observed. Age and the presence of an appendicolith are important risk factors for perforation. Obstruction may be caused by 1,23:"
"CT is highly sensitive (94-98%) and specific (up to 97%) for the diagnosis of acute appendicitis and allows for alternative causes of abdominal pain to be diagnosed. The need for contrast (IV, oral, or both) is debatable and varies from institution to institution. Oral contrast has not been shown to increase the sensitivity of CT 12. Nonetheless, many radiologists advocate the use of oral contrast in patients with a low BMI ("
"In ~30% of cases where the appendix has become gangrenous and perforated, initial non-operative management is preferred, provided that the patient is stable. In this situation, radiologists have a therapeutic role to play with percutaneous CT- or US-guided drainage of periappendiceal abscesses >3 cm. Smaller collections may be managed with antibiotics and interval appendicectomy."
"inflammation may be initially limited to the distal end of the appendix (tip appendicitis). Further assessment with CT or MR is indicated if the tip is not seen on US"
"Alvarado score"
"Meckel diverticulitis"
"CT has drastically reduced the negative appendicectomy (i.e. removal of a normal appendix) rate. This is important because appendicectomy has been linked with mood/anxiety disorders (if performed in childhood) 39, inflammatory bowel disease, cardiovascular disease, type 2 diabetes, Parkinson disease and Alzheimer disease, and the risk of recurrent Clostridioides difficile colitis is 4 times greater"
Expected headings
"Complications"
"rebound tenderness over the appendix (e.g. RIF: McBurney sign)"
"Appendicitis should not be diagnosed by size alone. Normal appendices can measure 13 mm in width and 35 cm in length, so it is important to consider the ancillary findings of obstruction, ischaemia, inflammation and perforation. Obstruction is highly associated with perforation and complications whereas cases of ‘simple’ non-obstructive appendicitis may have a benign course, resolving spontaneously. These cases may be caused by viral infection."
"the presence of intraluminal, intramural or periappendiceal gas locules with an obstructed appendix strongly suggests necrosis (gangrenous appendicitis) 35-37; this is in contradistinction to the presence of intraluminal gas in a normal-appearing appendix"
"the normal appendix contains normal intraluminal gas, faeces and mucus"
"in patients over 40 presenting with complicated appendicitis (abscess or phlegmon), an underlying appendiceal neoplasm should be considered; reported rates of occult malignancy in this group range from 2.3% to 12% — CT findings that warrant mention in the report include an appendiceal diameter >14 mm, nodular or asymmetric wall thickening, and a soft tissue mass at the appendiceal base, as these may prompt colonoscopy or interval appendicectomy 43,44"
"the presence of intraluminal, intramural or periappendiceal gas locules with an obstructed appendix strongly suggests necrosis (gangrenous appendicitis) 35-37; this is in contradistinction to the presence of intraluminal gas in a normal-appearing appendix"
"most specifically, appendiceal abscess or extraluminal gas; also periappendiceal phlegmon and fluid 20"
"in patients over 40 presenting with complicated appendicitis (abscess or phlegmon), an underlying appendiceal neoplasm should be considered; reported rates of occult malignancy in this group range from 2.3% to 12% — CT findings that warrant mention in the report include an appendiceal diameter >14 mm, nodular or asymmetric wall thickening, and a soft tissue mass at the appendiceal base, as these may prompt colonoscopy or interval appendicectomy 43,44"