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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 - 2cc/kg– Enhances inflammatory processes
• Helical (spiral) multidetector technique
• May use oral and/or rectal contrast
Appendiceal Wall Thickening
• Enlarged appendix
(> 6mm diameter)
• Appendiceal wall thickening (>2mm)
Appendiceal Wall Thickening
• Enlarged appendix
(> 6mm diameter)
• Appendiceal wall thickening (>2mm)
Wall Enhancement
• Enlarged appendix
(> 6mm diameter)
• Appendiceal wall thickening (>2mm)
• Appendiceal wall enhancement
Wall Enhancement
• Enlarged appendix
(> 6mm diameter)
• Appendiceal wall thickening (>2mm)
• Appendiceal wall enhancement
Fat Stranding
• Enlarged appendix (> 6mm diameter)
• Appendiceal wall thickening (>2mm)
• Appendiceal wall enhancement
• Periappendiceal fat stranding
Fat Stranding
• Enlarged appendix (> 6mm diameter)
• Appendiceal wall thickening (>2mm)
• Appendiceal wall enhancement
• Periappendiceal fat stranding
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