April 2009

An unusual case of appendicitis

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Clinical information

Pain in the right lower abdomen and raised infection parameters

Ultrasound Images & Clips

77 year old female, Pain in the right lower abdomen and raised infection parameters

Longitudinal image of the thickened and not compressible appendix

Transverse image of the thickened and not compressible appendix

Transverse image of the thickened not compressible appendix with vascularized wall

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

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

CT image with the cecal mass and thickened appendix

CT image with the cecal mass

Conclusion

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.

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

Details

Sex: Female
Age: 77

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Author

Dr. Taco Geertsma

Retired Radiologist, Gelderse Vallei Hospital

Dr. Taco Geertsma is the founder of UltrasoundCases.info and a retired radiologist and has worked in the Gelderse Vallei hospital from January 1, 1983. till July 1, 2014. He was the head of the ultrasound department for many years.

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