Radiology Case Presentation By Matt Cole. Clinical Information Clinical history: 60 year old white female who presented with a 1 week history of abdominal.

Slides:



Advertisements
Similar presentations
A site specific approach to radiologic diagnosis
Advertisements

History Age: 17 months History: Female infant with recent history of low grade fever. Presented to the ER on August 8th with increasing episodes of intermittent.
Appendicitis in pregnancy
THE ACUTE ABDOMEN Patients with an acute abdomen comprise the largest group of people presenting as a general surgical emergency. In most acute abdominal.
MedPix Medical Image Database COW - Case of the Week Case Contributor: Michael Krasnokutsky Affiliation: Uniformed Services University.
Pt. suffered from chronic intermittent abdominal pain for the last 3-4 months. Over the 24 hours prior to coming into the ER her pain is greatly worsened.
Overview and CT Imaging Examples of Common Colon Pathologies
 Dr. Mirzaei.  One of the most common surgical emergencies  Highest incidence in the second and third decades.
CASE: RLQ Pain A 17 year old otherwise healthy female presents to the University Hospital emergency department with a 12 hour history of fever and abdominal.
1. Which of the following is the most common cause of acute appendicitis? A. Fecalith B. Foreign body C. Tumor of the appendix D. Lymphoid hyperplasia.
IMAGING for ABDOMINAL PAIN
Imaging of acute appendicitis and it’s complications.
Appendicitis. Pathophysiology Obstruction of lumen causes diffuse pain Intraluminal bacterial overgrowth causes: –Mucosal breakdown –Bacterial invasion.
Acute Abdomen Ashna Khurana, MD. Case 1 4 yo male with abdominal pain, n/v, poor appetite, and fevers to 102 x 2-3 days. Vitals: T102, HR 140s, BP 90/50,
ACUTE APPENDICITIS Roy Phitayakorn, M.D. Christopher Brandt, M.D. Case Western Reserve University School of Medicine.
Bernard M. Jaffe, MD Professor of Surgery, Emeritus
Diseases of the Appendix
Acute Appendicitis Dr Ibrahim Bashayreh.
Diagnosis of diverticulosis and diverticulitis
ACUTE APPENDICITIS By : Niloofar Azizi.
Abdominal Imaging Cases.
Air and Fluid on Computed Tomography Tinika Montgomery University of Virginia School of Medicine February 24, 2006.
For: Nottingham SCRUBS 26th August 2006
2-year-old with Abdominal Pain Case MRN
A Case of Crohn’s Disease Rich Rames, M3 May/June 2013 Dr. Joy Sclamberg, Dr. James Cameron, Dr. Aditi Gulabani.
Ectopic Pregnancy Susana Smith Harbutt February, 2013 Dr. Joy Sclamberg.
DATE TOPIC PARTICIPENT 1-Feb-09 intersting cases all residents
Acut e Appendicitis. Epidemiology  It affects 6~7 % of the population.  Peak incidence in adolescents and young adults, with a slight male predominance.
MedPix Medical Image Database COW - Case of the Week Case Contributor: Alex Galifianakis Affiliation: Uniformed Services University.
Two days of progressive abdominal pain in teenage girl Paul Lewis, MD James Cameron, MD January 2012.
MedPix Medical Image Database COW - Case of the Week Case Contributor: Jason Capra Affiliation: Uniformed Services University.
Acute abdomen Case presentation
DR MOSES ACAN DEPARTMENT OF RADIOLOGY
Evaluation of Acute Appendicitis in Children using Bedside Ultrasound Amanda Bates.
Differentials. Acute appendicitis Epigastric/periumbilical pain(RUQ) Pain, anorexia, nausea and vomiting, fever (pain or vomiting will come first before.
Inflammation Case Presentation
EM Clerkship: Abdominal Pain. Objectives Standard approach to abdominal pain as CC Broad differential diagnosis development Properly use labs and studies.
Biliary Imaging Ian Scharrer, MIV. Clinical Scenario A 46 year old woman presents to the clinic complaining of epigastric pain that she experiences after.
Interval Appendectomy
9 y/o girl H/o of JRA treated with methotrexate and enbrel 4 day h/o abdominal pain Nausea/emesis Urinary retention.
Michael J. Campbell, MD Virginia Mason Medical Center Seattle, Washington.
Meckel’s Diverticulum as a Cause of Bowel Obstruction
Variations in topographic position of the appendix.
Diverticulitis Ultrasound
Right Lower Quadrant Pain: Value of the Nonvisualized Appendix in Patients at Multidetector CT Suvranu Ganguli, MD, Vassilios Raptopoulos, MD, Fabio Komlos,
SONOGRAPHY OF THE APPENDIX
Appendicitis.
Perforated Appendicitis: management options
Appendicitis in Children
Non-operative management of “the” classic surgical disease?
Post-Traumatic Long Segment Small Bowel Stricture A Diagnostic Dilemma
AMYAND’S HERNIA : CASE STUDY AND REVIEW OFLITERATURE
Inflammation Case Presentation
Appendicitis.
Dr. Kevin J. Pacheco Abdominal Pain.
Case studies December 2007 C.M.R.I..
Introduction to Surgical Department AXR
Diagnosis of acute appendicitis
JN 71 yo F.
Diagnosis of diverticulosis and diverticulitis
Appendicitis.
I.M. Sechenov First Moscow State Medical University
Presented by: J. Karl Pineda
“Must Know” GI Radiology for Family medicine residents
Radiology of the abdomen
急性闌尾炎 Acute appendicitis
Appendicitis.
Case Western Reserve University
Case studies December 2007 C.M.R.I..
Presentation transcript:

Radiology Case Presentation By Matt Cole

Clinical Information Clinical history: 60 year old white female who presented with a 1 week history of abdominal pain, worse in the RLQ, with recent increased intensity. Some intermittent N/V, no changes in bowel habits, no decreased appetite, no fever/chills.

Clinical Information Physical Exam: Afebrile, Vital Signs within normal limits, Abdominal exam revealed tenderness in the RLQ, positive rebound tenderness with pain radiating to the RLQ, minimal rigidity or guarding. Lab tests showed a normal white count, normal U/A, normal LFTs, normal lipase

Imaging The following imaging studies were obtained: –Chest x-ray –Abdominal series –Abdomen/Pelvis CT Both the CXR and the Abdominal series were within normal limits. The CT showed the following…

CT Findings Abnormally enlarged appendix (9.5 mm) with mild adjacent inflammatory stranding, compatible with appendicitis. Appendix lies in the mid and left pelvis and not the RLQ.

Hospital Course Based on history, physical exam, and CT findings, she was felt to have appendicitis. She was taken to the OR where a laparoscopic appendectomy was performed. The appendix was noted to be inflamed but not perforated. Final pathology reported the diagnosis to be “acute appendicitis”.

Radiographic features of appendicitis Plain Abdominal Radiograph –The presence of a calcified appendiceal fecalith occurs in fewer than 10% of cases. –Radiographic signs suggesting appendicitis include convex lumbar scoliosis, obliteration of right psoas margin, right lower quadrant air-fluid levels, air in the appendix, or localized ileus. –In rare cases, a perforated appendix may produce pneumoperitoneum. Ultrasound –Especially useful for pediatric appendicitis. –The finding of a noncompressible dilated appendix is a strong indicator of nonperforated appendicitis. –After perforation, ultrasound can identify a periappendiceal phlegmon or abscess formation. –Additional findings that can support the diagnosis of appendicitis include the presence of appendicoliths, fluid in the appendiceal lumen, focal tenderness over the inflamed appendix, and a transverse diameter of 6 mm or more.

CT diagnosis of Appendicitis The most useful features to diagnose appendicitis on CT include enlarged appendix (> 6cm), appendiceal wall thickening, periappendiceal fat stranding, and appendiceal wall enhancement. Other features can include appendicolith, appendiceal intraluminal air, intramural air, and abscess.

ACR CODE ACR CODE: 75.29

References Grainger & Allison's Diagnostic Radiology: A Textbook of Medical Imaging, 4th Ed., Copyright © 2001 Churchill Livingstone, Inc.