CT and MRI features of acute appendicitis

CT and MRI features of acute appendicitis

The most specific imaging finding is an abnormal appendix that is typically dilated to ≥ 6 mm and fluid-filled. Visualization of a calcified appendicolith (best seen on CT) with associated periappendiceal inflammatory fat stranding or edema is also highly specific. Other imaging findings may include:

  • • Hyperenhancement of the appendiceal wall.
  • • Thickening of the appendiceal wall ( ≥ 3 mm), sometimes with low attenuation/high T2-weighted signal intensity submucosal edema in the wall (leading to mural stratification or a “target” sign).
  • • Reactive thickening of adjacent cecum or small bowel.
  • • Arrowhead-shaped funneling of the cecal apex toward the occluded appendiceal lumen (“arrowhead” sign).
  • • A curved soft tissue structure between the cecal lumen and an appendicolith, which is representative of an inflamed cecal or appendiceal wall (“cecal bar” sign).
  • • Periappendiceal fluid.
  • • Thickening and enhancement of the adjacent parietal peritoneum representing focal peritonitis.

Complications include appendiceal perforation with abscess formation, small bowel obstruction, and mesenteric venous thrombosis.


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