Appendicitis Pathophysiology Obstruction of lumen causes diffuse pain

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

Enlarged Appendix • Enlarged appendix (> 6 mm diameter)

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

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

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

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

Appendicolith • Seen in 20 -40% of patients

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