1. Appendicitis

2. Pathophysiology Obstruction of lumen causes diffuse pain Intraluminal bacterial overgrowth causes: –Mucosal breakdown –Bacterial invasion of appendiceal wall –Inflammation --> peritonitis --> localized pain –Perforation E. coli, Peptostreptococcus B. fragilis, Pseudomonas

3. Technique IV contrast - 2cc/kg –Enhances inflammatory processes Helical (spiral) multidetector technique May use oral and/or rectal contrast

4. Enlarged Appendix Enlarged appendix (> 6mm diameter)

5. Enlarged Appendix Enlarged appendix (> 6mm diameter) 12mm

6. Appendiceal Wall Thickening Enlarged appendix (> 6mm diameter) Appendiceal wall thickening (>2mm)

7. Appendiceal Wall Thickening Enlarged appendix (> 6mm diameter) Appendiceal wall thickening (>2mm)

8. Wall Enhancement Enlarged appendix (> 6mm diameter) Appendiceal wall thickening (>2mm) Appendiceal wall enhancement

9. Wall Enhancement Enlarged appendix (> 6mm diameter) Appendiceal wall thickening (>2mm) Appendiceal wall enhancement

10. Fat Stranding Enlarged appendix (> 6mm diameter) Appendiceal wall thickening (>2mm) Appendiceal wall enhancement Periappendiceal fat stranding

11. Fat Stranding Enlarged appendix (> 6mm diameter) Appendiceal wall thickening (>2mm) Appendiceal wall enhancement Periappendiceal fat stranding

12. Appendicolith Seen in 20-40% of patients

13. Appendicolith Seen in 20-40% of patients

14. Target Structure Concentric thickening of the inflamed appendiceal wall

15. Target Structure Concentric thickening of the inflamed appendiceal wall

16. Intraluminal Air

17. Case Review Case 12 - 10 year old male with RLQ painCase 12 - Case 15 - 8 year old male with RLQ painCase 15 Case 26 - 10 year old male with RLQ painCase 26 Case 27 - 12 year old male with RLQ painCase 27 Case 43 - 5 year old male with RLQ painCase 43 Case 65 - 8 year old male with RLQ painCase 65