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Case of the Month

April 2009

Patient Data: 77 year old female

Clinical Info: Pain in the right lower abdomen and raised infection parameters


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Longitudinal image of the thickened and not compressible appendix


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Transverse image of the thickened and not compressible appendix


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Transverse image of the thickened not compressible appendix with vascularized wall


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Longitudinal image of the base of the appendix shows an obstructing mass


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Longitudinal image of the cecum and appendix with a large cecal mass obstructing the base of the appendix and the thickened fluid filled inflamed appendix


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CT image with the cecal mass and thickened appendix


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CT image with the cecal mass

In the case of an appendicitis it is always important to look for a possible cause. In many cases a fecolith is seen obstructing the appendix. Also an inflamed appendix can be secondary to other inflammatory bowel diseases. Especially in older patients an appendicitis can be caused by an obstructing cecal mass.

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References
Puylaert JB. Ultrasonography of the acute abdomen: gastrointestinal conditions.Radiol Clin North Am. 2003 Nov;41(6):1227-42, vii. Review

Brown MA. Imaging acute appendicitis Semin Ultrasound CT MR. 2008 Oct;29(5):293-307. Review

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