Learning objectives
To present the CT protocols and the key imaging features in the diagnosis of acute appendicitis.
To discuss and illustrate the main complications of acute appendicitis.
To highlight the CT aspects that help differentiate between acute appendicitis and other inflammatory or neoplastic lesions of the ileocecal region.
Background
INTRODUCTION
Right lower quadrant pain is a common clinical presentation in the emergency room [1].
Acute appendicitis is one of the most common causes of right lower quadrant pain and the most common condition that requires surgery in childhood.
Because of low costs and availability,
ultrasound is sometimes preferred as the initial imaging modality,
but it is often inconclusive.
Spiral CT is more sensitive and specific,
therefore is the imaging modality of choice in adult patients presenting with right lower quadrant pain [2],
[3].
CLINICAL...
Findings and procedure details
CT technique
Our most common technique is scanning between the diaphragm to the pubic symphysis,
using both intravenous and oral administration of contrast (on a 16 or 64 slice MDCT).
Oral contrast was preferred and administered depending on the clinical status of the patient.
The CT protocols are listed below:
NECT - 1000 ml of oral contrast (positive or negative) was administered 1 hour prior to the examination (5 mm collimation,
pitch = 1.0,
120 kV,
180 mAs)
CECT – injection of 1.5 ml/kg of...
Conclusion
CT scan is essential in the management of patients with acute abdomen,
establishing the right diagnosis between the numerous pathologies that mimic appendicitis both clinically and imaging wise.
CT scan is currently the most accurate tool for the diagnosis of acute appendicitis and its severe complications,
for the adult population.
The CT protocol must be adapted to the clinical suspicion,
but also to the comorbidities frequently associated in adult patients.
References
1.Macaluso CR,
McNamara RM.
“ Evaluation and management of acute abdominal pain in the emergency department”.International Journal of General Medicine.
2012;5:789-797.
2.Leite NP,
Pereira JM et al.
“CT evaluation of appendicitis and its complications: imaging techniques and key diagnostic findings”.
American Journal of Roentgenology.
2005; 185: 406-417.
3.Dahabreh IJ,
Adam GP et al.
“Diagnosis of Right Lower Quadrant Pain and Suspected Acute Appendicitis.
Rockville (MD): Agency for Healthcare Research and Quality (US)”.
2015 Dec (Comparative Effectiveness Reviews,
No.
157).
4.Petroianu A.
“Diagnosis of acute appendicitis”....