E4754. CT of Appendicitis in Adults: Problematic Scans and Scenarios
  1. Douglas Katz; NYU Langone Hospital - Long Island
  2. Miltiadis Tembelis; NYU Langone Hospital - Long Island
  3. Aranz Khalilollahi; NYU Langone Hospital - Long Island
  4. John Hines; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
  5. Perry Pickhardt; University of Wisconsin
  6. Michael Patlas; University of Toronto
A nontrivial minority of CT examinations performed for suspected appendicitis, regardless of the protocol utilized, end up being challenging to interpret for a variety of reasons in adults.

Educational Goals / Teaching Points
This exhibit will review problematic scenarios and situations involving CT performed for right lower quadrant pain in nonpregnant adults, including reviews of uncommon, atypical, or unusual presentations of appendicitis and its potential mimics and potential pitfalls, as well as some of the more common problematic scenarios. This exhibit will also demonstrate examples of these CT scenarios from our practices and briefly overview QA and medical-legal issues in suspected appendicitis in adults with an emphasis on CT.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
-Oral contrast: to use or not to use on CT? -Subtle/early findings. -Perforated appendicitis: review of the literature. -The right lower quadrant ‘phlegmon.’ -Potential pitfalls and confounders: right colonic diverticulitis, ‘secondary’ appendicitis, distal/tip appendicitis, the nonvisualized appendix, chronic/relapsing appendicitis, and resolving appendicitis. -Appendicitis and rotation anomalies. -Stump appendicitis. -Appendicitis in hernias. -Appendicitis and underlying neoplasms. -Additional potential errors, quality assurance issues, and medical-legal issues.

Suspected appendicitis is a common indication for imaging in the emergency department. Often these scans can be straight forward, but in a nontrivial number of patients, radiologist may encounter less common appendix pathology and appendicitis mimics. Knowledge of the alternative pathologies, mimics, and variants can help radiologists when facing a challenging scan and provide better quality care to their patients.