Skip to main content

Advertisement

SpringerLink
Log in

Review of appendicitis: routine, complicated, and mimics

  • Review Article
  • Published:
Emergency Radiology Aims and scope Submit manuscript

Abstract

Appendicitis is one of the most common sources of abdominal pain in the emergency setting and is generally considered a straightforward diagnosis. However, atypical appearances, non-visualization, and inconclusive features can make these cases more complicated. The objectives of this article are to review the differential diagnoses for right lower quadrant pain, discuss the imaging characteristics of simple appendicitis on computed tomography (CT), and provide guidance for equivocal cases, complicated appendicitis, and appendicitis mimics. This review will also discuss the identification and management of neoplasms of the appendix.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10

Similar content being viewed by others

References

  1. Pinto Leite N, Pereira JM, Cunha R, Pinto P, Sirlin C (2005) CT evaluation of appendicitis and its complications: imaging techniques and key diagnostic findings. AJR Am J Roentgenol 185(2):406–417. https://doi.org/10.2214/ajr.185.2.01850406

    Article  Google Scholar 

  2. Daly CP, Cohan RH, Francis IR, Caoili EM, Ellis JH, Nan B (2005) Incidence of acute appendicitis in patients with equivocal CT findings. AJR Am J Roentgenol 184(6):1813–1820. https://doi.org/10.2214/ajr.184.6.01841813

    Article  Google Scholar 

  3. Moteki T, Horikoshi H (2007) New CT criterion for acute appendicitis: maximum depth of intraluminal appendiceal fluid. AJR Am J Roentgenol 188(5):1313–1319. https://doi.org/10.2214/ajr.06.1180

    Article  Google Scholar 

  4. Tamburrini S, Brunetti A, Brown M, Sirlin CB, Casola G (2005) CT appearance of the normal appendix in adults. Eur Radiol 15(10):2096–2103. https://doi.org/10.1007/s00330-005-2784-z

    Article  Google Scholar 

  5. Webb EM, Wang ZJ, Coakley FV, Poder L, Westphalen AC, Yeh BM (2010) The equivocal appendix at CT: prevalence in a control population. Emerg Radiol 17(1):57–61. https://doi.org/10.1007/s10140-009-0826-6

    Article  Google Scholar 

  6. Leung B, Madhuripan N, Bittner K et al (2019) Clinical outcomes following identification of tip appendicitis on ultrasonography and CT scan. J Pediatr Surg 54(1):108–111. https://doi.org/10.1016/j.jpedsurg.2018.10.019

    Article  Google Scholar 

  7. Wilson EB, Cole JC, Nipper ML, Cooney DR, Smith RW (2001) Computed tomography and ultrasonography in the diagnosis of appendicitis: When are they indicated? Arch Surg 136(6):670–675. https://doi.org/10.1001/archsurg.136.6.670

    Article  CAS  Google Scholar 

  8. April MD, Long B (2018) What is the diagnostic accuracy of magnetic resonance imaging for acute appendicitis? Ann Emerg Med 72(3):308–309. https://doi.org/10.1016/j.annemergmed.2017.09.014

    Article  Google Scholar 

  9. Mazeh H, Epelboym I, Reinherz J, Greenstein AJ, Divino CM (2009) Tip appendicitis: clinical implications and management. Am J Surg 197(2):211–215. https://doi.org/10.1016/j.amjsurg.2008.04.016

    Article  Google Scholar 

  10. Dikicier E, Altintoprak F, Ozdemir K, et al. Stump appendicitis: a retrospective review of 3130 consecutive appendectomy cases (2018) World J Emerg Surg 13(22). https://doi.org/10.1186/s13017-018-0182-5

  11. Quadri R, Vasan V, Hester C, Porembka M, Fielding J (2019) Comprehensive review of typical and atypical pathology of the appendix on CT: cases with clinical implications. Clin Imaging 53:65–77. https://doi.org/10.1016/j.clinimag.2018.08.016

    Article  Google Scholar 

  12. Johnston J, Myers DT, Williams TR (2015) Stump appendicitis: surgical background, CT appearance, and imaging mimics. Emerg Radiol 22(1):13–18. https://doi.org/10.1007/s10140-014-1253-x

    Article  Google Scholar 

  13. Subramanian A, Liang MK (2012) A 60-year literature review of stump appendicitis: the need for a critical view. Am J Surg 203(4):503–507. https://doi.org/10.1016/j.amjsurg.2011.04.009

    Article  Google Scholar 

  14. Ganguli S, Raptopoulos V, Komlos F, Siewert B, Kruskal JB (2006) Right lower quadrant pain: value of the nonvisualized appendix in patients at multidetector CT. Radiology 241(1):175–180. https://doi.org/10.1148/radiol.241105019

    Article  Google Scholar 

  15. Nikolaidis P, Hwang CM, Miller FH, Papanicolaou N (2004) The nonvisualized appendix: incidence of acute appendicitis when secondary inflammatory changes are absent. AJR Am J Roentgenol 183(4):889–892. https://doi.org/10.2214/ajr.183.4.1830889

    Article  Google Scholar 

  16. Gaskill CE, Simianu VV, Carnell J et al (2018) Use of computed tomography to determine perforation in patients with acute appendicitis. Curr Probl Diagn Radiol 47(1):6–9. https://doi.org/10.1067/j.cpradiol.2016.12.002

    Article  Google Scholar 

  17. Pickhardt PJ, Bhalla S (2002) Intestinal malrotation in adolescents and adults: spectrum of clinical and imaging features. AJR Am J Roentgenol 179(6):1429–1435. https://doi.org/10.2214/ajr.179.6.1791429

    Article  Google Scholar 

  18. Kim HY, Park JH, Lee YJ, Lee SS, Jeon JJ, Lee KH (2018) Systematic review and meta-analysis of CT features for differentiating complicated and uncomplicated appendicitis. Radiology 287(1):104–115. https://doi.org/10.1148/radiol.2017171260

    Article  Google Scholar 

  19. Yoon SH, Lee MJ, Jung SY, Ho IG, Kim MK (2019) Mesenteric venous thrombosis as a complication of appendicitis in an adolescent: a case report and literature review. Medicine (Baltimore) 98(48):e18002. https://doi.org/10.1097/MD.0000000000018002

    Article  Google Scholar 

  20. Kim MS, Park HW, Park JY et al (2014) Differentiation of early perforated from nonperforated appendicitis: MDCT findings, MDCT diagnostic performance, and clinical outcome. Abdom Imaging 39(3):459–466. https://doi.org/10.1007/s00261-014-0117-x

    Article  Google Scholar 

  21. Tsuboi M, Takase K, Kaneda I et al (2008) Perforated and nonperforated appendicitis: defect in enhancing appendiceal wall–depiction with multi-detector row CT. Radiology 246(1):142–147. https://doi.org/10.1148/radiol.2461051760

    Article  Google Scholar 

  22. Ishiyama M, Yanase F, Taketa T et al (2013) Significance of size and location of appendicoliths as exacerbating factor of acute appendicitis. Emerg Radiol 20(2):125–130. https://doi.org/10.1007/s10140-012-1093-5

    Article  Google Scholar 

  23. Khan MS, Chaudhry MBH, Shahzad N, Tariq M, Memon WA, Alvi AR (2018) Risk of appendicitis in patients with incidentally discovered appendicoliths. J Surg Res 221:84–87. https://doi.org/10.1016/j.jss.2017.08.021

    Article  Google Scholar 

  24. Soyer P, Boudiaf M, Dray X et al (2010) Crohn’s disease: multi-detector row CT-enteroclysis appearance of the appendix. Abdom Imaging 35(6):654–660. https://doi.org/10.1007/s00261-009-9575-y

    Article  Google Scholar 

  25. Douglas C, Rotimi O (2004) Extragenital endometriosis–a clinicopathological review of a Glasgow hospital experience with case illustrations. J Obstet Gynaecol 24(7):804–808. https://doi.org/10.1080/01443610400009568

    Article  CAS  Google Scholar 

  26. El Hentour K, Millet I, Pages-Bouic E, Curros-Doyon F, Molinari N, Taourel P (2018) How to differentiate acute pelvic inflammatory disease from acute appendicitis? A decision tree based on CT findings. Eur Radiol 28(2):673–682. https://doi.org/10.1007/s00330-017-5032-4

    Article  Google Scholar 

  27. Rakovich G (2006) Diverticulosis of the appendix. Dig Surg 23(1–2):26. https://doi.org/10.1159/000092801

    Article  Google Scholar 

  28. Gray R, Danks R, Lesh M, Diaz-Arias A (2021) Congenital appendiceal diverticulum: an incidental finding during an appendectomy. Cureus 13(4):e14488. https://doi.org/10.7759/cureus.14488

    Article  Google Scholar 

  29. Singh AK, Gervais DA, Hahn PF, Sagar P, Mueller PR, Novelline RA (2005) Acute epiploic appendagitis and its mimics. Radiographics 25(6):1521–1534. https://doi.org/10.1148/rg.256055030

    Article  Google Scholar 

  30. Naar L, Kim P, Byerly S et al (2020) Increased risk of malignancy for patients older than 40 years with appendicitis and an appendix wider than 10 mm on computed tomography scan: a post hoc analysis of an EAST multicenter study. Surgery 68(4):701–706. https://doi.org/10.1016/j.surg.2020.05.04

    Article  Google Scholar 

  31. Pickhardt PJ, Levy AD, Rohrmann CA Jr, Kende AI (2003) Primary neoplasms of the appendix: radiologic spectrum of disease with pathologic correlation [published correction appears in Radiographics. 2003 Sep-Oct;23(5):1340]. Radiographics 23(3):645–662. 1148/rg.233025134

  32. Leonards LM, Pahwa A, Patel MK, Petersen J, Nguyen MJ, Jude CM (2017) Neoplasms of the appendix: pictorial review with clinical and pathologic correlation. Radiographics 37(4):1059–1083. https://doi.org/10.1148/rg.2017160150

    Article  Google Scholar 

  33. Marotta B, Chaudhry S, McNaught A et al (2019) Predicting underlying neoplasms in appendiceal mucoceles at CT: focal versus diffuse luminal dilatation. AJR Am J Roentgenol 213(2):343–348. https://doi.org/10.2214/AJR.18.20562

    Article  Google Scholar 

  34. Roggo A, Wood WC, Ottinger LW (1993) Carcinoid tumors of the appendix. Ann Surg 217(4):385–390. https://doi.org/10.1097/00000658-199304000-00010

    Article  CAS  Google Scholar 

  35. Tchana-Sato V, Detry O, Polus M et al (2006) Carcinoid tumor of the appendix: a consecutive series from 1237 appendectomies. World J Gastroenterol 12(41):6699–6701. https://doi.org/10.3748/wjg.v12.i41.6699

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA

    Joshua C. Hunsaker, Rebekah Aquino, Brad Wright, Patrick Kobes, Anne Kennedy & Dell Dunn

  2. Department of Radiology, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, USA

    Brad Wright, Patrick Kobes & Dell Dunn

Authors
  1. Joshua C. Hunsaker
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rebekah Aquino
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Brad Wright
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Patrick Kobes
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Anne Kennedy
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Dell Dunn
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dell Dunn.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hunsaker, J.C., Aquino, R., Wright, B. et al. Review of appendicitis: routine, complicated, and mimics. Emerg Radiol 30, 107–117 (2023). https://doi.org/10.1007/s10140-022-02098-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10140-022-02098-2

Keywords

Search

Navigation