Anatomical variants of the appendix and CT - US findings of appendicitis - a practical guide for young radiologist.

Congress:

ECR 2019

Poster Number:

C-2035

Type:

Educational Exhibit

Keywords:

Anatomy, Abdomen, Gastrointestinal tract, CT, Ultrasound, Ultrasound-Colour Doppler, Education, Inflammation, Acute

Authors:

O. A. Furmaga¹, A. KARAKOUSIS¹, D. Sidiropoulos¹, K. Koutroumanidis¹, I. Tsanaktsidis¹, I. Tsifountoudis¹, N. J. Skoulikaris², M. A. Kuczyńska³, E. Dionisiadis¹; ¹Thessaloniki/GR, ²Kavala/GR, ³Lublin/PL

DOI:

10.26044/ecr2019/C-2035

DOI-Link:

https://dx.doi.org/10.26044/ecr2019/C-2035

Fig. 1: Coronal and sagittal CT reformatted images illustrate the retrocaecal...

Fig. 2: Axial IV-contrast-enhanced CT scans illustrate the normal appendix in pelvic...

Fig. 3: Coronal CT reformatted image and axial CT scan of a patient with pain in the...

Fig. 4: Longitudinal US scan illustrates a non-compressible appendix with laminated...

Learning objectives

- To provide a comprehensive review of the anatomy of the appendix and illustrate its variants on CT and US. - To highlight the criteria for recognition of appendicitis in CT and US, in order to provide their better understanding.

Background

APPENDICITIS Appendicitis is considered to be among the most common pathologies to be observed at the emergency department worldwide as well as among the most common reasons for emergent abdominal surgery. The diagnosis of acute appendicitis is being made on the basis of physical examination together with laboratory tests and well-taken history of the patient. The radiological evaluation should be asked predominantly in order to establish the diagnosis in atypical cases. It is important to recognize acute appendicitis correctly, even in atypical location, because a...

Findings and procedure details

All the images have been collected in a prospective way from the 15th of May 2018 till the 30th of September 2018 from the selected patients of Greek origin between 19 and 73 years old presenting to the emergency department with the clinical suspicion of appendicitis. All the relevant images were obtained by a 64-slices computed tomography scanner and an ultrasound device. HELICAL COMPUTED TOMOGRAPHY In case of clinical suspicion of appendicitis, helical CT scan of the abdomen including pelvis is the most conservative and...

Conclusion

Acute appendicitis is one of the most common surgical emergencies. Identification of a normal appendix is critical to exclude the possibility of inflammation. Due to many anatomical variations of the location of appendix described, its radiological evaluation can be challenging. Although experience of the operator is desirable, sonography of the organ is becoming more frequent in the emergency departments as an initial diagnostic tool. CT remains the examination of choice for patients where appendix is not visualized on US scans. The final choice of the...

Personal information

References

1. O'Connor, Catherine E., and William P. Reed. In vivo location of the human vermiform appendix. Clinical Anatomy 1994;7:139-142. 2. Oto A., Ernst R.D., Mileski W.J., Nishino T.K., Le O., Wolfe G.C., Chaljub G. Localization of appendix with MDCT and influence of findings on choice of appendectomy incision.AJR Am. J. Roentgenol2006;187(4):987–990. 3. Bhasin SK, Khan AB, Kumar V, Sharma S, Saraf R. Vermiform appendix and acute appendicitis. JK Science 2007;9:167-70. 4. Sobotta, J., Paulsen, F., Waschke, J., Klonisch, T. and Hombach-Klonisch, S. Sobotta atlas of...