Acute appendicitis diagnosis requires assessment of inflammatory signs (periappendiceal fat stranding and free fluid) rather than appendix size alone, as a dilated appendix without surrounding inflammation may not indicate true pathology.
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10/100 | Random Radiology Dump | #appendicitis #ctscan #radiologyshortsAjouté :
Stop diagnosing appendicitis based on size alone. You might be missing the actual pathology. Look right here. This is a 45-year-old male who came with right lower abdominal pain and vomiting.
We trace the appendix arising from the cecum, which is retrocecal in position.
But a mildly prominent appendix alone does not mean appendicitis. The real question is, is there inflammation around it? And here comes the answer.
There is definite periappendiceal fat stranding, and right next to it minimal free fluid in the right iliac fossa. The appendix is dilated, measuring about 12 mm in this case. Also, look inside the lumen. There are multiple small appendicoliths. They aren't impacted at the base, but they can still cause luminal stasis, slowly increasing the intraluminal pressure, and triggering the inflammatory cascade.
This is a perfect example of acute uncomplicated appendicitis caught right in action. So, would you send a 12-mm appendix with zero adjacent fat stranding straight to the OR, or would you hold off and manage conservatively?
Let me know in the comments.
Thank you.
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