Skip to main content
SpringerLink
Log in

The Appendix

  • Chapter
  • First Online:
Cross-Sectional Imaging of the Abdomen and Pelvis

  • 2788 Accesses

Abstract

Evaluation of the appendix is a frequent indication for cross-sectional imaging, in particular in the emergency department setting. The following chapter reviews appendiceal gross and microscopic anatomy, imaging protocols, and an algorithmic approach for evaluation of the appendix.

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

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 199.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 279.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. April EW. Gastrointestinal tract. In: Clinical anatomy. 3rd ed. Philadelphia: Williams & Wilkins; 1997. p. 367–84.

    Google Scholar 

  2. Ross MH, Romrell LJ, Kaye GI. Digestive system II: esophagus and gastrointestinal tract. In: Histology: a text and atlas. 3rd ed. Philadelphia: Williams & Wilkins; 1995. p. 468.

    Google Scholar 

  3. Bollinger RR, Barbas AS, Bush EL, Lin SS, Parker W. Biofilms in the large bowel suggest an apparent function of the human vermiform appendix. J Theor Biol. 2007;249:826–31.

    Article  CAS  Google Scholar 

  4. Johnson PT, Horton KM, Mahesh M, Fishman E. Multidetector computed tomography for suspected appendicitis: multi-institutional survey of 16-MDCT data acquisition protocols and review of pertinent literature. J Comput Assist Tomogr. 2006;30:758–64.

    Article  Google Scholar 

  5. Rao PM, Rhea JT, Novelline RA, Mostafavi AA, Lawrason JN, McCabe CJ. Helical CT combined with contrast material administered only through the colon for imaging of suspected appendicitis. AJR Am J Roentgenol. 1997;169:1275–80.

    Article  CAS  Google Scholar 

  6. Anderson BA, Salem L, Flum DR. A systematic review of whether oral contrast is necessary for the computed tomography diagnosis of appendicitis in adults. Am J Surg. 2005;190:474–8.

    Article  Google Scholar 

  7. Anderson SW, Soto JA, Lucey BC, et al. Abdominal 64-MDCT for suspected acute appendicitis: the use of oral and IV contrast material versus IV contrast material only. AJR Am J Roentgenol. 2009;193:1281–8.

    Article  Google Scholar 

  8. Keyzer C, Cullus P, Tack D, De Maertelaer V, Bohy P, Gevenois PA. MDCT for suspected acute appendicitis in adults: impact of oral and IV contrast media at standard-dose and simulated low-dose techniques. AJR Am J Roentgenol. 2009;193:1272–81.

    Article  Google Scholar 

  9. Bush WH, Swanson DP. Acute reactions to intravascular contrast media: types, risk factors, recognition and specific treatment. AJR Am J Roentgenol. 1991;157:1153–61.

    Article  CAS  Google Scholar 

  10. Wang CL, Cohan RH, Ellis JH, Adusumilli S, Dunnick NR. Frequency, management, and outcome of extravasation of nonionic iodinated contrast medium in 69657 intravenous injections. Radiology. 2007;243:80–7.

    Article  Google Scholar 

  11. Berj KJ. Nephrotoxicity related to contrast media. Scan J Urol Nephrol. 2000;34:317–22.

    Article  Google Scholar 

  12. Jacobs JE, Birnbaum BA, Macari M, et al. Acute appendicitis: comparison of helical CT diagnosis focused technique with oral contrast material versus non-focused technique with oral and intravenous contrast material. Radiology. 2001;220:683–90.

    Article  CAS  Google Scholar 

  13. Wise SW, Labuski MR, Kasales CJ, et al. Comparative assessment of CT and sonographic techniques for appendiceal imaging. AJR Am J Roentgenol. 2001;176:933–41.

    Article  CAS  Google Scholar 

  14. Urban BA, Fishman EK. Tailored helical CT evaluation of acute abdomen. Radiographics. 2000;20:725–49.

    Article  CAS  Google Scholar 

  15. Paulson EK, Harris JP, Jaffe TA, Haugan PA, Nelson RC. Acute appendicitis: added diagnostic values of coronal reformations from isotropic voxels at multi-detector row CT. Radiology. 2005;235:879–85.

    Article  Google Scholar 

  16. Kim HC, Yang DM, Jin W, Park SJ. Added diagnostic value of multi-planar reformations of multi-detector CT data in patients with suspected appendicitis. Radiographics. 2008;28:393–405.

    Article  CAS  Google Scholar 

  17. Benjaminov O, Atri M, Hamilton P, Rappaport D. Frequency of visualization and thickness of normal appendix at nonenhanced helical CT. Radiology. 2002;225:400–6.

    Article  Google Scholar 

  18. Lee KS, Rofsky NM, Pedrosa I. Location of the appendix at MR imaging during pregnancy: utility of the cecal tilt angle. Radiology. 2008;249:134–41.

    Article  Google Scholar 

  19. Tamburrini S, Brunetti A, Brown M, Sirlin CB, Casola G. CT appearance of the normal appendix in adults. Eur Radiol. 2005;15:2096–103.

    Article  Google Scholar 

  20. Johnson PT, Eng J, Moore CJ, Horton KM, Fishman EK. Multi-detector row CT of the appendix in healthy adults. Emerg Radiol. 2006;12:248–53.

    Article  Google Scholar 

  21. Rettenbacher T, Hollerweger A, Macheiner P, et al. Outer diameter of the vermiform appendix as a sign of acute appendicitis: evaluation at US. Radiology. 2001;218:757–62.

    Article  CAS  Google Scholar 

  22. Nikolaidis P, Hwang CM, Miller FH, Papanicolaou N. The nonvisualized appendix: incidence of acute appendicitis when secondary inflammatory changes are absent. AJR. 2004;183:889–92.

    Article  Google Scholar 

  23. Ganguli S, Raptopoulos V, Komlos F, Siewert B, Kruskal JB. Right lower quadrant pain: value of the nonvisualized appendix in patients at multidetector CT. Radiology. 2006;241:175–80.

    Article  Google Scholar 

  24. Keyzer C, Pargov S, Tack D, et al. Normal appendix in adults: reproducibility of detection with unenhanced and contrast-enhanced MDCT. AJR Am J Roentgenol. 2008;191:507–14.

    Article  Google Scholar 

  25. Kim HC, Yang DM, Shin HP. Why can we not see a normal appendix on CT? An evaluation of the factors influencing nonvisualization of a normal appendix by 64-slice MDCT. Clin Radiol. 2009;33:33–8.

    Google Scholar 

  26. Coursey CA, Nelson RC, Patel MB, et al. Making the diagnosis of acute appendicitis: do more preoperative CT scans mean fewer negative appendectomies? A 10-year study. Radiology. 2010;254:460–8.

    Article  Google Scholar 

  27. Coursey CA, Nelson RC, Moreno RD, Patel MB, Beam CA, Vaslef S. Appendicitis, body mass index and CT: is CT more valuable for obese patients than thin patients? Am Surg. 2011;77:471–5.

    PubMed  Google Scholar 

  28. Birnbaum BA, Wilson SR. Appendicitis at the millennium. Radiology. 2000;215:337–48.

    Article  CAS  Google Scholar 

  29. Lane MJ, Katz DS, Ross BA, Clautice-Engle TL, Mindelzun RE, Jeffrey Jr RB. Unenhanced helical CT for suspected acute appendicitis. AJR Am J Roentgenol. 1997;168:405–9.

    Article  CAS  Google Scholar 

  30. Rao PM, Rhea JT, Novelline RA, et al. Helical CT technique for the diagnosis of appendicitis: prospective evaluation of a focused appendix examination. Radiology. 1997;202:139–44.

    Article  CAS  Google Scholar 

  31. Pinto Leite N, Pereira JM, Cunha R, Pinto P, Sirlin C. CT evaluation of appendicitis and its complications: imaging techniques and key diagnostic findings. AJR Am J Roentgenol. 2005;185:406–17.

    Article  Google Scholar 

  32. Choi D, Park H, Lee YR, et al. The most useful findings for diagnosis acute appendicitis on contrast-enhanced helical CT. Acta Radiol. 2003;44:574–82.

    Article  CAS  Google Scholar 

  33. Funaki B, Grosskreutz SR, Funaki CN. Using unenhanced helical CT with enteric contrast material for suspected appendicitis in patients treated at a community hospital. AJR Am J Roentgenol. 1998;171:997–1001.

    Article  CAS  Google Scholar 

  34. Keyzer C, Tack D, de Maertelaer V, Bohy P, Gevenois PA, Gansbeke DV. Acute appendicitis: comparison of low-dose and standard-dose unenhanced multi-detector row CT. Radiology. 2004;232:164–72.

    Article  Google Scholar 

  35. Horrow MM, White DS, Horrow JC. Differentiation of perforated from nonperforated appendicitis at CT. Radiology. 2003;227:46–51.

    Article  Google Scholar 

  36. Bixby SD, Lucey BC, Soto JA, Theysohn JM, Ozonoff A, Varghese JC. Perforated versus nonperforated acute appendicitis: accuracy of multidetector CT detection. Radiology. 2006;241:780–6.

    Article  Google Scholar 

  37. Coursey CA, Nelson RC, Moreno RD, Dodd LG, Patel MB, Vaslef S. Carcinoid tumors of the appendix: are these tumors identifiable prospectively at preoperative CT. Am Surg. 2010;76:273–5.

    PubMed  Google Scholar 

  38. Pickhardt PJ, Levy AD, Rohrmann Jr CA, Kende AI. Primary neoplasms of the appendix: radiologic spectrum of disease with pathologic correlation. Radiographics. 2003;23:645–62.

    Article  Google Scholar 

  39. In’t Hof KH, van der Wal HC, Vander Wal HC, Kazemier G, Lange JF. Carcinoid tumor of the appendix: an analysis of 1,485 consecutive emergency appendectomies. J Gastrointest Surg. 2008;12:1436–8.

    Article  Google Scholar 

  40. Tchana-Sato V, Detry O, Polus M, et al. Carcinoid tumor of the appendix: a consecutive series from 1237 appendectomies. World J Gastroenterol. 2006;41:699–701.

    Google Scholar 

  41. Moertel CG, Weiland LH, Nagorney DM, Dockerty MB. Carcinoid tumor of the appendix: treatment and prognosis. N Engl J Med. 1987;317:1699–701.

    Article  CAS  Google Scholar 

  42. Kim SH, Lim HK, Lee WJ, Lim JH, Byun JY. Mucocele of the appendix: ultrasonographic and CT appearance. Abdom Imaging. 1998;23:292–6.

    Article  CAS  Google Scholar 

  43. Carr NJ, McCarthy WF, Sobin LH. Epithelial noncarcinoid tumors and tumor-like lesions of the appendix: a clinicopathologic study of 184 patients with a multivariate analysis of prognostic factors. Cancer. 1995;75:757–68.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Abdominal Imaging, Cleveland Clinic, Cleveland, OH, USA

    Devaraju Kanmaniraja MD

  2. Department of Radiology and Imaging Sciences, Emory Healthcare, Emory University School of Medicine, Atlanta, GA, USA

    Courtney Coursey Moreno MD

  3. Department of Surgery, The Southeast Permanente Medical Group, Kaiser Permanente, Atlanta, GA, USA

    Ricardo D. Moreno MD

  4. Imaging Institute, Cleveland Clinic, Cleveland, OH, USA

    Shetal N. Shah MD

Authors
  1. Devaraju Kanmaniraja MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Courtney Coursey Moreno MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ricardo D. Moreno MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shetal N. Shah MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Devaraju Kanmaniraja MD .

Editor information

Editors and Affiliations

  1. Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Khaled M. Elsayes MD

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer Science+Business Media New York

About this chapter

Cite this chapter

Kanmaniraja, D., Moreno, C.C., Moreno, R.D., Shah, S.N. (2015). The Appendix. In: Elsayes, K.M. (eds) Cross-Sectional Imaging of the Abdomen and Pelvis. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1884-3_13

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-1884-3_13

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-1883-6

  • Online ISBN: 978-1-4939-1884-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation