E2276. Imaging of the Appendix: A Case-Based Multimodality Pictorial Review of Various Diseases of the Appendix and Its impact on Decision Making
  1. Peter Markee; Rush University Medical Center
  2. Pokhraj Suthar; Rush University Medical Center
  3. Sumeet Virmani; Rush University Medical Center
Imaging is crucial in the diagnosis of infectious, inflammatory, and neoplastic etiologies of the appendix. A normal appendix on imaging rules out the most common causes of right lower quadrant abdominal pain. We present a case based pictorial review of a spectrum of common and uncommon appendicular pathologies with multimodality imaging correlation, underscoring its impact on decision making.

Educational Goals / Teaching Points
Interesting cases of various appendicular pathologies are highlighted. The characteristic imaging findings, multimodality correlation and impact on decision making are presented in this pictorial review. These include a) location of the inflamed appendix (retrocecal, subcecal, pelvic or ileal) and its impact on surgery; b) laparoscopic vs open, and if open what type of incision; c) degree and extent of inflammation in deciding open vs laparoscopic approach; d) phlegmon (surgery vs conservative management); e) unilocular vs multilocular collections and abscesses (IR vs open drainage); f) mucocele; g) appendicular mass (surgery vs staging); h) follow up imaging of incidental carcinoid of the appendix on histology; i) incidental appendiceal pathology on PET CT; j) appendicitis in the pediatric and pregnant population.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
We present 15 interesting cases with multimodality imaging correlation highlighting its impact on decision making. Multimodality correlation with x-ray, Ultrasound, CT, MRI, and PET CT is provided where available.

Imaging plays a key role in decision making for various appendicular pathologies including but not limited to conservative vs surgical management, laparoscopic vs open approach, IR vs surgical drainage, emergent vs elective surgery, and last but not the least differentiating appendicular vs non-appendicular pathology for right lower quadrant abdominal pain.