E5086. Challenging Cases, Pearls, and Pitfalls of the Appendix
Authors
Joseph Brazier;
Corewell Health William Beaumont University Hospital
Allan Brazier;
Corewell Health William Beaumont University Hospital
Adela Pouzar;
Corewell Health William Beaumont University Hospital
Monisha Shetty;
Corewell Health William Beaumont University Hospital
Farnoosh Sokhandon;
Corewell Health William Beaumont University Hospital
Nathan Kolderman;
Corewell Health William Beaumont University Hospital
Sayf Al-Katib;
Corewell Health William Beaumont University Hospital
Background
The vermiform appendix is perhaps the most important vestigial organ in the body that the radiologist must be able to identify. Many variations in size, location, and position of the appendix exist, and there is a wide spectrum of pathologic processes that have overlapping radiographic features. The purpose of this presentation is to review the spectrum of benign and pathologic entities of the appendix that are challenging in everyday practice.
Educational Goals / Teaching Points
Review challenging cases involving the appendix that have significant overlapping features on imaging, as well as to highlight key clinical history, anatomic relationships, and imaging characteristics that will improve the diagnostic acumen of the interpreting radiologist when evaluating the appendix. Supplemental histopathologic correlation will also be shown when applicable.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
This review will include cases from our institution highlighting key imaging features to avoid pitfalls in appendiceal pathology. We will discuss the radiographic features of the normal appendix and classify cases into five categories as follows. 1 - Infectious/inflammatory etiologies (example case: appendiceal diverticulitis); 2 - malignant etiologies (example case: prostate cancer metastasis to the appendix); 3 - inflammatory etiologies mimicking malignancy (example case: mass-like appendicitis); 4 - variant anatomy (example case: appendicitis in nonrotation); and 5 - malignant etiologies mimicking appendicitis. Other cases not presented in the example slides will include: appendicitis in an Amyand hernia, inverted appendix, perforated appendicitis with tubo-ovarian abscess (TOA) mimicking a cystic ovarian neoplasm, acute or chronic appendicitis with extensive fibrosis, appendiceal mucocele, appendiceal malignancy causing small bowel obstruction (SBO), carcinoid of the appendix, and Crohn disease of the appendix with ileoappendiceal fistula.
Conclusion
There are many variant and pathologic entities of the appendix encountered in everyday practice, some of which have overlapping features on imaging. This can pose a challenge to the interpreting radiologist, as benign processes can mimic malignancy, and vice versa. Awareness of key imaging features and common pitfalls can lead to more accurate diagnoses and better patient outcomes.
