- Acute appendicitis is one of the most common causes of acute abdominal pain.
- It is the most common condition that requires abdominal surgery in childhood.
- It is the most common condition associated with lawsuits against emergency physicians.
- Acute appendicitis occurs when the appendiceal lumen is obstructed, leading to fluid accumulation, luminal distention, inflammation, and, finally, perforation.
- Clinically and laboratory:
- Periumbilical pain that shifts to the right lower quadrant
- Nausea, vomiting, and anorexia
- Rebound tenderness
- Leukocytosis (seen in approx 80% of patients with appendicitis)
- Abscess formation
- Although appendicitis traditionally has been a clinical diagnosis, many patients are found to have normal appendixes at surgery.
- A rate of unnecessary removal as high as 20% has been considered acceptable in the surgery literature. However, negative laparotomy can be avoided in many patients if modern diagnostic methods are used to confirm or exclude acute appendicitis.
- CT has high accuracy for the noninvasive assessment of patients with suspected appendicitis, with reported
 Imaging Findings
- Appendiceal thickening with the outer-wall-to-outer-wall transverse diameter greater than 6 mm.
- Some authors define appendiceal thickening on CT as transverse diameter greater than 7 mm
- The appendiceal diameter probably should be interpreted in the context of clinical and other
- Appendiceal wall thickening (wall ≥ 3mm)
- Appendiceal wall hyperenhancement
- Mural stratification of the appendiceal wall
- Appendicolith(s) (present in one third of patients with appendicitis).
- Cecal apical thickening (diffuse as opposed to apical cecal thickening is also possible, but this is less specific for appendicitis).
- Periappendiceal inflammation includes periappendiceal fat stranding, thickening of the lateral conal fascia, and mesoappendix, extraluminal fluid, phlegmon, abscess, ileocecal mild lymph node enlargement, and inflammatory thickening of contiguous structures.
Patient #1: Right lower quadrant pain
Patient #2: Right lower quadrant pain
Patient #3: Right lower quadrant pain
 See Also
 External Links
- E-medicine: radiology article
- Pinto Leite, Nuno, Pereira, Jose M., Cunha, Rui, Pinto, Pedro, Sirlin, Claude. CT Evaluation of Appendicitis and Its Complications: Imaging Techniques and Key Diagnostic Findings. Am. J. Roentgenol. 2005 185: 406-417.