Longitudinal image showing a massive thickened appendix with a fecolith at the tip.
Transverse image showing the same massive thickened appendix.
Transverse image with color doppler showing vascularization of the appendiceal wall.
Longitudinal image with color doppler showing vascularization of the appendiceal wall.
There is not only thickening of the appendix but also of the cecal wall.
Longitudinal image of the thickened cecal wall with thumb printing.
Because this was not a normal presentation of an acute appendicitis the patient was not operated, but instead a biopsy was performed which showed granulomas highly suggestive for Crohn´s disease. No signs of malignancy were found.
In cases of acute appendicitis there can also sometimes be a massive thickened appendix as in this case.
One should always remember that a thickened appendix does not always means that there is an acute appendicitis as in this case of non Hodgkin´s lymphoma.