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Appendicitis

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.

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Appendicitis

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  1. Appendicitis

  2. 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

  3. Technique • IV contrast - 2cc/kg • Enhances inflammatory processes • Helical (spiral) multidetector technique • May use oral and/or rectal contrast

  4. Enlarged Appendix • Enlarged appendix (> 6mm diameter)

  5. Enlarged Appendix • Enlarged appendix (> 6mm diameter) 12mm

  6. Appendiceal Wall Thickening • Enlarged appendix (> 6mm diameter) • Appendiceal wall thickening (>2mm)

  7. Appendiceal Wall Thickening • Enlarged appendix (> 6mm diameter) • Appendiceal wall thickening (>2mm)

  8. Wall Enhancement • Enlarged appendix (> 6mm diameter) • Appendiceal wall thickening (>2mm) • Appendiceal wall enhancement

  9. Wall Enhancement • Enlarged appendix (> 6mm diameter) • Appendiceal wall thickening (>2mm) • Appendiceal wall enhancement

  10. Fat Stranding • Enlarged appendix (> 6mm diameter) • Appendiceal wall thickening (>2mm) • Appendiceal wall enhancement • Periappendiceal fat stranding

  11. Fat Stranding • Enlarged appendix (> 6mm diameter) • Appendiceal wall thickening (>2mm) • Appendiceal wall enhancement • Periappendiceal fat stranding

  12. Appendicolith • Seen in 20-40% of patients

  13. Appendicolith • Seen in 20-40% of patients

  14. Target Structure • Concentric thickening of the inflamed appendiceal wall

  15. Target Structure • Concentric thickening of the inflamed appendiceal wall

  16. Intraluminal Air

  17. 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

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