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Appendicitis
Atif Zaheer, MD; Michael P. Federle, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Definitions

            • Acute appendiceal inflammation due to luminal obstruction and superimposed infection

          IMAGING

          • General Features

            • Radiographic Findings

              • CT Findings

                • MR Findings

                  • Ultrasonographic Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Staging, Grading, & Classification

                            • Gross Pathologic & Surgical Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Image Interpretation Pearls

                                          Selected References

                                          1. Mahankali SK et al: CT based acute appendicitis severity index for acute appendicitis and validate its effectiveness in predicting complicated appendicitis. Emerg Radiol. ePub, 2021
                                          2. Kave M et al: Pregnancy and appendicitis: a systematic review and meta-analysis on the clinical use of MRI in diagnosis of appendicitis in pregnant women. World J Emerg Surg. 14:37, 2019
                                          3. Mervak BM et al: MRI in pregnancy: indications and practical considerations. J Magn Reson Imaging. 49(3):621-31, 2019
                                          4. Mervak BM et al: MRI of acute appendicitis. J Magn Reson Imaging. 50(5):1367-76, 2019
                                          5. Poletti PA et al: Suspicion of appendicitis in pregnant women: emergency evaluation by sonography and low-dose CT with oral contrast. Eur Radiol. 29(1):345-52, 2019
                                          6. Quadri R et al: Comprehensive review of typical and atypical pathology of the appendix on CT: cases with clinical implications. Clin Imaging. 53:65-77, 2019
                                          7. Rud B et al: Computed tomography for diagnosis of acute appendicitis in adults. Cochrane Database Syst Rev. 2019(11), 2019
                                          8. Tang SJ et al: Positive oral contrast solution at MDCT for suspected acute appendicitis in adults: rate of appendiceal luminal filling of normal and inflamed appendixes. AJR Am J Roentgenol. 1-7, 2019
                                          9. Tyler PD et al: The potential role of ultrasound in the work-up of appendicitis in the emergency department. J Emerg Med. 56(2):191-6, 2019
                                          10. Expert Panel on Gastrointestinal Imaging et al: ACR Appropriateness Criteria® right lower quadrant pain-suspected appendicitis. J Am Coll Radiol. 15(11S):S373-87, 2018
                                          11. Shin I et al: Optimisation of the MR protocol in pregnant women with suspected acute appendicitis. Eur Radiol. 28(2):514-21, 2018
                                          12. Kinner S et al: Diagnostic accuracy of MRI versus CT for the evaluation of acute appendicitis in children and young adults. AJR Am J Roentgenol. 209(4):911-19, 2017
                                          13. Yun SJ et al: Comparison of low- and standard-dose CT for the diagnosis of acute appendicitis: A meta-analysis. AJR Am J Roentgenol. 208(6):W198-207, 2017
                                          14. Hines JJ et al: Beyond appendicitis; radiologic review of unusual and rare pathology of the appendix. Abdom Radiol (NY). 41(3):568-81, 2016
                                          15. Bhangu A et al: Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. Lancet. 386(10000):1278-87, 2015
                                          16. Kim Y et al: Increasing utilization of abdominal CT in the emergency department of a secondary care center: does it produce better outcomes in caring for pediatric surgical patients? Ann Surg Treat Res. 87(5):239-44, 2014
                                          17. Smith MP et al: ACR Appropriateness Criteria® right lower quadrant pain-suspected appendicitis. Ultrasound Q. 31(2):85-91, 2014
                                          18. Garcia K et al: Suspected appendicitis in children: diagnostic importance of normal abdominopelvic CT findings with nonvisualized appendix. Radiology. 250(2):531-7, 2009
                                          19. Wan MJ et al: Acute appendicitis in young children: cost-effectiveness of US versus CT in diagnosis--a Markov decision analytic model. Radiology. 250(2):378-86, 2009
                                          20. Brown MA: Imaging acute appendicitis. Semin Ultrasound CT MR. 29(5):293-307, 2008
                                          21. Singh AK et al: Dropped appendicolith: CT findings and implications for management. AJR Am J Roentgenol. 190(3):707-11, 2008
                                          22. van Randen A et al: Acute appendicitis: meta-analysis of diagnostic performance of CT and graded compression US related to prevalence of disease. Radiology. 249(1):97-106, 2008
                                          23. Doria AS et al: US or CT for diagnosis of appendicitis in children and adults? A meta-analysis. Radiology. 241(1):83-94, 2006
                                          24. Oto A et al: Right-lower-quadrant pain and suspected appendicitis in pregnant women: evaluation with MR imaging--initial experience. Radiology. 234(2):445-51, 2005
                                          25. Paulson EK et al: Acute appendicitis: added diagnostic value of coronal reformations from isotropic voxels at multi-detector row CT. Radiology. 235(3):879-85, 2005
                                          26. Andersson RE: Meta-analysis of the clinical and laboratory diagnosis of appendicitis. Br J Surg. 91(1):28-37, 2004
                                          27. Kessler N et al: Appendicitis: evaluation of sensitivity, specificity, and predictive values of US, Doppler US, and laboratory findings. Radiology. 230(2):472-8, 2004
                                          28. Horrow MM et al: Differentiation of perforated from nonperforated appendicitis at CT. Radiology. 227(1):46-51, 2003
                                          29. Jacobs JE et al: CT imaging in acute appendicitis: techniques and controversies. Semin Ultrasound CT MR. 24(2):96-100, 2003
                                          30. Lee JH: Sonography of acute appendicitis. Semin Ultrasound CT MR. 24(2):83-90, 2003
                                          31. Macari M et al: The acute right lower quadrant: CT evaluation. Radiol Clin North Am. 41(6):1117-36, 2003
                                          32. Neumayer L et al: Imaging in appendicitis: a review with special emphasis on the treatment of women. Obstet Gynecol. 102(6):1404-9, 2003
                                          33. O'Malley ME et al: US of gastrointestinal tract abnormalities with CT correlation. Radiographics. 23(1):59-72, 2003
                                          34. Paulson EK et al: Clinical practice. Suspected appendicitis. N Engl J Med. 348(3):236-42, 2003
                                          35. Puylaert JB: Ultrasonography of the acute abdomen: gastrointestinal conditions. Radiol Clin North Am. 41(6):1227-42, vii, 2003
                                          36. Wijetunga R et al: The CT diagnosis of acute appendicitis. Semin Ultrasound CT MR. 24(2):101-6, 2003
                                          37. Bendeck SE et al: Imaging for suspected appendicitis: negative appendectomy and perforation rates. Radiology. 225(1):131-6, 2002
                                          38. Callahan MJ et al: CT of appendicitis in children. Radiology. 224(2):325-32, 2002
                                          39. Raman SS et al: Accuracy of nonfocused helical CT for the diagnosis of acute appendicitis: a 5-year review. AJR Am J Roentgenol. 178(6):1319-25, 2002
                                          40. Jones PF: Suspected acute appendicitis: trends in management over 30 years. Br J Surg. 88(12):1570-7, 2001
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Top Differential Diagnoses

                                                • Clinical Issues

                                                  TERMINOLOGY

                                                  • Definitions

                                                    • Acute appendiceal inflammation due to luminal obstruction and superimposed infection

                                                  IMAGING

                                                  • General Features

                                                    • Radiographic Findings

                                                      • CT Findings

                                                        • MR Findings

                                                          • Ultrasonographic Findings

                                                            • Imaging Recommendations

                                                              DIFFERENTIAL DIAGNOSIS

                                                                PATHOLOGY

                                                                • General Features

                                                                  • Staging, Grading, & Classification

                                                                    • Gross Pathologic & Surgical Features

                                                                      • Microscopic Features

                                                                        CLINICAL ISSUES

                                                                        • Presentation

                                                                          • Demographics

                                                                            • Natural History & Prognosis

                                                                              DIAGNOSTIC CHECKLIST

                                                                              • Consider

                                                                                • Image Interpretation Pearls

                                                                                  Selected References

                                                                                  1. Mahankali SK et al: CT based acute appendicitis severity index for acute appendicitis and validate its effectiveness in predicting complicated appendicitis. Emerg Radiol. ePub, 2021
                                                                                  2. Kave M et al: Pregnancy and appendicitis: a systematic review and meta-analysis on the clinical use of MRI in diagnosis of appendicitis in pregnant women. World J Emerg Surg. 14:37, 2019
                                                                                  3. Mervak BM et al: MRI in pregnancy: indications and practical considerations. J Magn Reson Imaging. 49(3):621-31, 2019
                                                                                  4. Mervak BM et al: MRI of acute appendicitis. J Magn Reson Imaging. 50(5):1367-76, 2019
                                                                                  5. Poletti PA et al: Suspicion of appendicitis in pregnant women: emergency evaluation by sonography and low-dose CT with oral contrast. Eur Radiol. 29(1):345-52, 2019
                                                                                  6. Quadri R et al: Comprehensive review of typical and atypical pathology of the appendix on CT: cases with clinical implications. Clin Imaging. 53:65-77, 2019
                                                                                  7. Rud B et al: Computed tomography for diagnosis of acute appendicitis in adults. Cochrane Database Syst Rev. 2019(11), 2019
                                                                                  8. Tang SJ et al: Positive oral contrast solution at MDCT for suspected acute appendicitis in adults: rate of appendiceal luminal filling of normal and inflamed appendixes. AJR Am J Roentgenol. 1-7, 2019
                                                                                  9. Tyler PD et al: The potential role of ultrasound in the work-up of appendicitis in the emergency department. J Emerg Med. 56(2):191-6, 2019
                                                                                  10. Expert Panel on Gastrointestinal Imaging et al: ACR Appropriateness Criteria® right lower quadrant pain-suspected appendicitis. J Am Coll Radiol. 15(11S):S373-87, 2018
                                                                                  11. Shin I et al: Optimisation of the MR protocol in pregnant women with suspected acute appendicitis. Eur Radiol. 28(2):514-21, 2018
                                                                                  12. Kinner S et al: Diagnostic accuracy of MRI versus CT for the evaluation of acute appendicitis in children and young adults. AJR Am J Roentgenol. 209(4):911-19, 2017
                                                                                  13. Yun SJ et al: Comparison of low- and standard-dose CT for the diagnosis of acute appendicitis: A meta-analysis. AJR Am J Roentgenol. 208(6):W198-207, 2017
                                                                                  14. Hines JJ et al: Beyond appendicitis; radiologic review of unusual and rare pathology of the appendix. Abdom Radiol (NY). 41(3):568-81, 2016
                                                                                  15. Bhangu A et al: Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. Lancet. 386(10000):1278-87, 2015
                                                                                  16. Kim Y et al: Increasing utilization of abdominal CT in the emergency department of a secondary care center: does it produce better outcomes in caring for pediatric surgical patients? Ann Surg Treat Res. 87(5):239-44, 2014
                                                                                  17. Smith MP et al: ACR Appropriateness Criteria® right lower quadrant pain-suspected appendicitis. Ultrasound Q. 31(2):85-91, 2014
                                                                                  18. Garcia K et al: Suspected appendicitis in children: diagnostic importance of normal abdominopelvic CT findings with nonvisualized appendix. Radiology. 250(2):531-7, 2009
                                                                                  19. Wan MJ et al: Acute appendicitis in young children: cost-effectiveness of US versus CT in diagnosis--a Markov decision analytic model. Radiology. 250(2):378-86, 2009
                                                                                  20. Brown MA: Imaging acute appendicitis. Semin Ultrasound CT MR. 29(5):293-307, 2008
                                                                                  21. Singh AK et al: Dropped appendicolith: CT findings and implications for management. AJR Am J Roentgenol. 190(3):707-11, 2008
                                                                                  22. van Randen A et al: Acute appendicitis: meta-analysis of diagnostic performance of CT and graded compression US related to prevalence of disease. Radiology. 249(1):97-106, 2008
                                                                                  23. Doria AS et al: US or CT for diagnosis of appendicitis in children and adults? A meta-analysis. Radiology. 241(1):83-94, 2006
                                                                                  24. Oto A et al: Right-lower-quadrant pain and suspected appendicitis in pregnant women: evaluation with MR imaging--initial experience. Radiology. 234(2):445-51, 2005
                                                                                  25. Paulson EK et al: Acute appendicitis: added diagnostic value of coronal reformations from isotropic voxels at multi-detector row CT. Radiology. 235(3):879-85, 2005
                                                                                  26. Andersson RE: Meta-analysis of the clinical and laboratory diagnosis of appendicitis. Br J Surg. 91(1):28-37, 2004
                                                                                  27. Kessler N et al: Appendicitis: evaluation of sensitivity, specificity, and predictive values of US, Doppler US, and laboratory findings. Radiology. 230(2):472-8, 2004
                                                                                  28. Horrow MM et al: Differentiation of perforated from nonperforated appendicitis at CT. Radiology. 227(1):46-51, 2003
                                                                                  29. Jacobs JE et al: CT imaging in acute appendicitis: techniques and controversies. Semin Ultrasound CT MR. 24(2):96-100, 2003
                                                                                  30. Lee JH: Sonography of acute appendicitis. Semin Ultrasound CT MR. 24(2):83-90, 2003
                                                                                  31. Macari M et al: The acute right lower quadrant: CT evaluation. Radiol Clin North Am. 41(6):1117-36, 2003
                                                                                  32. Neumayer L et al: Imaging in appendicitis: a review with special emphasis on the treatment of women. Obstet Gynecol. 102(6):1404-9, 2003
                                                                                  33. O'Malley ME et al: US of gastrointestinal tract abnormalities with CT correlation. Radiographics. 23(1):59-72, 2003
                                                                                  34. Paulson EK et al: Clinical practice. Suspected appendicitis. N Engl J Med. 348(3):236-42, 2003
                                                                                  35. Puylaert JB: Ultrasonography of the acute abdomen: gastrointestinal conditions. Radiol Clin North Am. 41(6):1227-42, vii, 2003
                                                                                  36. Wijetunga R et al: The CT diagnosis of acute appendicitis. Semin Ultrasound CT MR. 24(2):101-6, 2003
                                                                                  37. Bendeck SE et al: Imaging for suspected appendicitis: negative appendectomy and perforation rates. Radiology. 225(1):131-6, 2002
                                                                                  38. Callahan MJ et al: CT of appendicitis in children. Radiology. 224(2):325-32, 2002
                                                                                  39. Raman SS et al: Accuracy of nonfocused helical CT for the diagnosis of acute appendicitis: a 5-year review. AJR Am J Roentgenol. 178(6):1319-25, 2002
                                                                                  40. Jones PF: Suspected acute appendicitis: trends in management over 30 years. Br J Surg. 88(12):1570-7, 2001