ARRS 2022 Abstracts


E1096. Acute Appendicitis? Think Again! Tips to Diagnose Common and Uncommon Appendiceal Pathologies
  1. Sana Majid; Brigham and Women's Hospital
  2. Ilana Warsofsky; Brigham and Women's Hospital
  3. Stuart Silverman; Brigham and Women's Hospital
  4. Shanna Matalon; Brigham and Women's Hospital
One of the most common causes of acute abdominal pain is appendicitis, and identification of the appendix is an important component of the search pattern for any abdominal or emergency radiologist. However, there are numerous other diseases that may clinically mimic acute appendicitis, including appendiceal neoplasm, inflammatory bowel disease, bowel malignancy, or metastatic disease. There are various imaging findings that can be helpful in developing an accurate diagnosis or differential diagnosis to help direct clinical management.

Educational Goals / Teaching Points
Diagnosing pathology of the appendix begins with its localization. Although usually in the right lower quadrant, the appendix may be positioned in unusual locations, particularly in patients who have a mobile cecum, are pregnant, have an abdominal malignancy, or a history of prior surgery. Knowledge of atypical locations and appearances can assist in minimizing diagnostic errors. Additionally, although the imaging appearance of benign and malignant diseases of the appendix may overlap, key imaging features such as enhancing intraluminal mass, can be used to develop a differential diagnosis that includes pathologies other than acute appendicitis. Some imaging features of unusual pathology can help guide management and need for surgical management beyond a simple appendectomy.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
This exhibit will provide illustrative case examples demonstrating typical and atypical locations of the appendix, utility of key features in evaluation for acute appendicitis (e.g., surrounding peri-appendiceal fat stranding changes, wall thickening, luminal caliber, appendicolith, presence of gas), common and unusual appearances of appendiceal pathology, and diseases that mimic acute appendicitis. We will also review imaging-guided recommendations for management of conditions other than acute appendicitis.

Evaluation of the appendix can be challenging, particularly in the setting of atypical anatomy and due to the overlap in imaging appearance of many of the most common appendiceal diseases. Knowledge of the varied appearance of appendiceal pathologies and key features can assist radiologists in discriminating between benign and malignant appendiceal disease and in directing management for patients.