Appendicitis

Describe the pathological changes of acute appendicitis.

The appendix is inflamed.
The lumen is filled with neutrophils.
The mucosa is ulcerated.
There is inflammation of visceral and parietal peritoneum.
Appendiceal inflammation is associated with obstruction in 50 to 80% of cases (due to fecolith, tumor or ball of worms - Oxyuriasis vermicularis).

What are the potential complications of acute appendicitis?

Perforation (most serious)
Pyelophlebitis with thrombosis of the portal vein
Liver abscess

The appendix is markedly swollen. The serosa is hyperemic and covered by a fibrinous exudate. Compare the inflammed appendix to the adjacent segments of a normal appendix.

What are the anticipated findings of appendicitis in imaging procedures?

Imaging Findings:

Appendicolith
Ileus: Dilated loops of bowel
Appendix is not compressible
Thick-walled appendix
Abnormally distended appendix
Appendix measures 7 mm or more
Periappendiceal inflammation/inflammatory infiltration of fat
Free fluid in cul de sac
Pericecal lymphadenopathy.
Cecal thickening
May have adjacent mass, abscess, etc.
Abscess
- Inflammatory mass
- Air pockets
- Contrast enhancement

Acute Appendicitis

CT scan showing

Dilated appendix
Dilated loops of bowel

CT scan showing Appendicolith

Arrow points to the appendicolith. Arrowhead points to the appendix.
Arrow points to the thickened bowel wall. Arrowheads point to inflammatory infiltration of the fat.

CT scan showing findings of appendiceal abscess.

Arrows point to the inflammatory mass in the right lower quadrant with an air pocket, indicating an abscess.

Mass demonstrates contrast enhancement.