There is a normal terminal ileum.
The appendix is not in its most common position
A normal looking appendix could be found in a retrocecal position
Longitudinal image of the normal looking appendix in a retrocecal position. There is some air in the lumen. No signs of inflammation
CT scan of the same patient shows a normal appendix in a retrocecal position
Two days later the patient was examined again because of persistent pain in the right lower abdomen and raised infection parameters.
Longitudinal image of the right kidney with a small amount of perirenal fluid. The appendix could be found in its retroce
Transverse image of the right kidney with perirenal effusion
There was also a small effusion at the undersurface of the right liver lobe. What was not noticed was a small round structure next to this effusion
The folowing day the ultrasound examination was repeated because the CRP had increased to 300. There is an increase of the effusion below the liver with tiny air bubbles. There is still a tiny amount of perirenal fluid
Again there is a rounded structure next to the effusion
The rounded structure was an inflamed tip of a very long retrocecal appendix. The largest part of the appendix still remained normal
videoclip of the appendix in transverse direction
Videoclip of the same patient in longitudinal direction.
A CT scan confirmed the findings. The patient was operated and an appendectomy was performed.
The following case shows that the diagnosis of a focal appendicitis of the tip is not always easy. This is a longitudinal image of an appendix of a 10 year old girl with suspicion of an appendicitis. The tip is slightly thickened
Detail of the tip of the appendix with vascularity
Transverse image of the tip with color doppler. The diameter is nearly 6 mm. which is just within normal limits, however it is more rounded and not compressible
Transverse image of the proximal appendix which is oval and measures 4,3 mm. The patient was operated because we found the ultrasound findings a bit suspicious for a moderate focal appendicitis. At operation a mildly thickened tip of the appendix was foun