Slide 1: A patient presents with abdominal pain, fever and leukocytosis. What is the cause of this presentation?

Slide 2: The patient has acute appendicitis, with a dilated appendix and secondary signs of inflammation.

CT scan showing normal appendix on the left. CT scan showing appendicitis on the right with reactive wall thickening of adjacent colon, enlarged, reactive lymph nodes in right lower quadrant, dilated appendix (width >7 mm), and surrounding fluid and fat stranding.

Slide 3: It is important to evaluate for the visualized complications which may prompt urgent intervention.

CT scan with appendiceal abscess on left. CT scan on the right showing extra luminal free air from perforation. This impacted calcified appendicolith is a common obstructive cause for appendicitis which has been associated with failure of antibiotic management.

Slide 4: Let’s consider a few imaging management considerations in acute appendicitis.

What is the imaging modality of choice? CT imaging with contrast is the recommended initial test for suspected appendicitis in adults.

Should oral contrast be used? Yes! Oral contrast can improve visualization of the appendix.

What CT findings increase risk of antibiotic failure? Dilated appendix >30 mm or obstructing appendicolith are more likely to need surgery.