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CT appearance of the normal appendix in adults

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Abstract

The aims of this study were to identify (1) the normal range of the appendix on computed tomography (CT), (2) the correlation of patient age and sex with the visibility and appearance of the appendix on CT, and (3) the normal variations in wall thickness, intraluminal content, and location of the appendix. Three hundred seventy-two outpatients underwent abdominopelvic CT. The scans were reviewed on the picture archiving and communication system and appendiceal outer-to-outer wall diameter, wall thickness, location, content and its correlation with appendix diameter were analyzed. The appendix was visualized in 305/372 patients. Its location relative to the cecum was highly variable. The diameter range was 3–10 mm; in 42% of cases the diameter was greater than 6 mm. When the intraluminal content (185/305) was visualized, the diameter was slightly superior to the mean (p=0.0156). In 329 CT scans in which oral contrast material was given, the appendix was filled by contrast material in 74/329 patients. The appendix wall thickness was measurable in 22/305 patients (average 0.15 cm). There is significant overlap between the normal and abnormal CT appearance of the appendix. Consequently the diagnosis of acute appendicitis should be based not only on the appearance of the appendix but also on the presence of secondary signs.

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References

  1. Hale DA et al (1997) Appendectomy: a contemporary appraisal. Ann Surg 225(3):252–261

    Article  CAS  PubMed  Google Scholar 

  2. van Breda Vriesman AC, Kole BJ, Puylaert JB (2003) Effect of ultrasonography and optional computed tomography on the outcome of appendectomy. Eur Radiol 13(10):2278–2282

    Article  PubMed  Google Scholar 

  3. Birnbaum BA, Wilson SR (2000) Appendicitis at the millennium. Radiology 215(2):337–348

    CAS  PubMed  Google Scholar 

  4. Wakeley CPG (1933) The position of vermiform appendix as described by analysis of 10.000 cases. J Anat 67:277–283

    Google Scholar 

  5. Rettenbacher T et al (2002) Appendicitis: should diagnostic imaging be performed if the clinical presentation is highly suggestive of the disease? Gastroenterology 123(4):992–998

    Article  PubMed  Google Scholar 

  6. Hui TT et al (2002) Outcome of elderly patients with appendicitis: effect of computed tomography and laparoscopy. Arch Surg 137(9):995–998; discussion 999–1000

    Article  PubMed  Google Scholar 

  7. Kalan M et al (1994) Evaluation of the modified Alvarado score in the diagnosis of acute appendicitis: a prospective study. Ann R Coll Surg Engl 76(6):418–419

    CAS  PubMed  Google Scholar 

  8. Flum DR, Koepsell T (2002) The clinical and economic correlates of misdiagnosed appendicitis: nationwide analysis. Arch Surg 137(7):799–804; discussion 804

    Article  PubMed  Google Scholar 

  9. Flum DR et al (2001) Has misdiagnosis of appendicitis decreased over time? A population-based analysis. JAMA 286(14):1748–1753

    Article  CAS  PubMed  Google Scholar 

  10. Dixon AK, Goldstone KE (2002) Abdominal CT and the euratom directive. Eur Radiol 12(6):1567–1570

    Article  PubMed  Google Scholar 

  11. Ege G et al (2002) Diagnostic value of unenhanced helical CT in adult patients with suspected acute appendicitis. Br J Radiol 75(897):721–725

    CAS  PubMed  Google Scholar 

  12. Benjaminov O et al (2002) Frequency of visualization and thickness of normal appendix at nonenhanced helical CT. Radiology 225(2):400–406

    PubMed  Google Scholar 

  13. Scatarige JC et al (1989) CT demonstration of the appendix in asymptomatic adults. Gastrointest Radiol 14(3):271–273

    CAS  PubMed  Google Scholar 

  14. Ghiatas AA et al (1997) Computed tomography of the normal appendix and acute appendicitis. Eur Radiol 7(7):1043–1047

    CAS  PubMed  Google Scholar 

  15. Grosskreutz S et al (1991) CT of the normal appendix. J Comput Assist Tomogr 15(4):575–577

    CAS  PubMed  Google Scholar 

  16. Rettenbacher T et al (2003) Ovoid shape of the vermiform appendix: a criterion to exclude acute appendicitis—evaluation with US. Radiology 226(1):95–100

    PubMed  Google Scholar 

  17. Simonovsky V (2001) The specificity of appendiceal outer diameter at US. Radiology 220(3):828–830

    CAS  PubMed  Google Scholar 

  18. Simonovsky V (1999) Sonographic detection of normal and abnormal appendix. Clin Radiol 54(8):533–539

    CAS  PubMed  Google Scholar 

  19. Hormann M et al (2003) Ultrasound of the appendix in children: is the child too obese? Eur Radiol 13(6):1428–1431

    PubMed  Google Scholar 

  20. Malone AJ Jr et al (1993) Diagnosis of acute appendicitis: value of unenhanced CT. Am J Roentgenol 160(4):763–766

    Google Scholar 

  21. Jacobs JE et al (2001) Acute appendicitis: comparison of helical CT diagnosis focused technique with oral contrast material versus nonfocused technique with oral and intravenous contrast material. Radiology 220(3):683–690

    CAS  PubMed  Google Scholar 

  22. Rao PM et al (1997) Helical CT combined with contrast material administered only through the colon for imaging of suspected appendicitis. Am J Roentgenol 169(5):1275–1280

    CAS  Google Scholar 

  23. Funaki B, Grosskreutz SR, Funaki CN (1998) Using unenhanced helical CT with enteric contrast material for suspected appendicitis in patients treated at a community hospital. Am J Roentgenol 171(4):997–1001

    CAS  Google Scholar 

  24. Weltman DI et al (2000) Diagnosis of acute appendicitis: comparison of 5- and 10-mm CT sections in the same patient. Radiology 216(1):172–177

    CAS  PubMed  Google Scholar 

  25. Rao PM, Rhea JT, Novelline RA (1997) Appendiceal and peri-appendiceal air at CT: prevalence, appearance and clinical significance. Clin Radiol 52(10):750–754

    CAS  PubMed  Google Scholar 

  26. Lowe LH et al (2000) Appendicolith revealed on CT in children with suspected appendicitis: how specific is it in the diagnosis of appendicitis? Am J Roentgenol 175(4):981–984

    CAS  Google Scholar 

  27. Lowe LH et al (2001) Appendicitis and alternate diagnoses in children: findings on unenhanced limited helical CT. Pediatr Radiol 31(8):569–577

    CAS  PubMed  Google Scholar 

  28. Simonovsky V (2002) Normal appendix: is there any significant difference in the maximal mural thickness at US between pediatric and adult populations? Radiology 224(2):333–337

    PubMed  Google Scholar 

  29. Shapiro MP, Gale ME, Gerzof SG (1989) CT of appendicitis. Diagnosis and treatment. Radiol Clin North Am 27(4):753–762

    CAS  PubMed  Google Scholar 

  30. Rao PM, Rhea JT, Novelline RA (1997) Sensitivity and specificity of the individual CT signs of appendicitis: experience with 200 helical appendiceal CT examinations. J Comput Assist Tomogr 21(5):686–692

    CAS  PubMed  Google Scholar 

  31. Gwynn LK (2002) Appendiceal enlargement as a criterion for clinical diagnosis of acute appendicitis: is it reliable and valid? J Emerg Med 23(1):9–14

    PubMed  Google Scholar 

  32. Wijetunga R et al (2001) Diagnostic accuracy of focused appendiceal CT in clinically equivocal cases of acute appendicitis. Radiology 221(3):747–753

    CAS  PubMed  Google Scholar 

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Acknowledgement

We are grateful to Davide Brunelli (http://www.med-ars.it) for creating Fig. 2 based on our data.

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Authors and Affiliations

  1. Dip. Sc. Biomorfologiche e Funzionali, Universita’ di Napoli Federico II, IBB-CNR, Via Pansini 5, 80131, Naples, Italy

    Stefania Tamburrini & Arturo Brunetti

  2. Via Pacuvio 25, 80122, Naples, Italy

    Stefania Tamburrini

  3. Department of Radiology, UCSD Medical Center, San Diego, CA, USA

    Stefania Tamburrini, Michèle Brown, Claude B. Sirlin & Giovanna Casola

Authors
  1. Stefania Tamburrini
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  2. Arturo Brunetti
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  3. Michèle Brown
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  4. Claude B. Sirlin
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  5. Giovanna Casola
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Correspondence to Stefania Tamburrini.

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

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  • DOI: https://doi.org/10.1007/s00330-005-2784-z

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