DOI QR코드

DOI QR Code

Multi-Detector CT Findings of Typical and Atypical Appendicitis: A Pictorial Essay

전형적 및 비전형적 충수염의 다중검출기컴퓨터단층촬영 소견: 임상화보

  • Na Ri Yun (Department of Radiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • You Dong Won (Department of Radiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Su Lim Lee (Department of Radiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
  • 윤나리 (가톨릭대학교 의과대학 의정부성모병원 영상의학과) ;
  • 원유동 (가톨릭대학교 의과대학 의정부성모병원 영상의학과) ;
  • 이수림 (가톨릭대학교 의과대학 의정부성모병원 영상의학과)
  • Received : 2023.03.21
  • Accepted : 2023.05.28
  • Published : 2023.09.01

Abstract

Multi-detector CT (MDCT) is a highly accurate diagnostic tool that is commonly used to evaluate appendicitis and its complications. The diagnosis of appendicitis based on MDCT findings can be difficult and challenging when the observed findings are inconsistent with the typical features. Atypical appendicitis includes a wide spectrum of features, such as variable positions of the appendix and cecum, complications, and unusual pathological findings of secondary appendicitis that mimic or induce appendicitis. Our pictorial essay describes the diverse spectrum of atypical appendicitis and appendicitis-like conditions in terms of location abnormalities, complications, and uncommon pathologies, including related tumors, reactive appendicitis, appendiceal diverticulitis, and IgG4-related disease. Through this essay, the readers can become more familiar with MDCT findings of atypical appendicitis.

다중검출기컴퓨터단층촬영(multi-detector CT; 이하 MDCT)은 높은 정확도를 가진 진단도구로서 충수염과 그 합병증을 평가하기 위해 보편적으로 사용된다. MDCT 소견에 근거한 충수염의 진단은 영상 소견이 전형적인 모습과 일치하지 않을 때 어려울 수 있다. 비전형적인 충수염에는 충수 및 맹장의 위치이상을 동반하는 경우, 합병증이 나타난 경우 그리고 충수염을 모방하거나 유발하는 병리학적 소견을 동반한 경우 등 다양한 스펙트럼의 질환이 포함된다. 본 임상화보는 비전형적이고 복잡한 충수염 및 충수염과 유사한 상태의 다양한 스펙트럼을 위치이상, 드문 합병증 및 종양, 반응성 충수염, 충수게실염, IgG4 연관 질환을 포함한 병리학적 이상의 관점에서 설명했다. 본 임상화보를 통해 독자들은 다양한 스펙트럼의 비전형적 충수염 MDCT 소견에 더 익숙해질 수 있다.

Keywords

References

  1. 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;185:406-417 https://doi.org/10.2214/ajr.185.2.01850406
  2. Quadri R, Vasan V, Hester C, Porembka M, Fielding J. Comprehensive review of typical and atypical pathology of the appendix on CT: cases with clinical implications. Clin Imaging 2019;53:65-77 https://doi.org/10.1016/j.clinimag.2018.08.016
  3. Lee SL, Ku YM, Choi BG, Byun JY. In vivo location of the vermiform appendix in multidetector CT. J Korean Soc Radiol 2014;70:283-289 https://doi.org/10.3348/jksr.2014.70.4.283
  4. Tang SJ, Wu R. Ilececum: a comprehensive review. Can J Gastroenterol Hepatol 2019;2019:1451835
  5. Schumpelick V, Dreuw B, Ophoff K, Prescher A. Appendix and cecum. Embryology, anatomy, and surgical applications. Surg Clin North Am 2000;80:295-318 https://doi.org/10.1016/S0039-6109(05)70407-2
  6. Kim SS, Kim YT, Shin HC, Kim SW, Kim IY. Various imaging features of intestinal malrotation, associated anomalies, and complications. J Korean Soc Radiol 2010;62:597-605 https://doi.org/10.3348/jksr.2010.62.6.597
  7. Pickhardt PJ, Bhalla S. Intestinal malrotation in adolescents and adults: spectrum of clinical and imaging features. AJR Am J Roentgenol 2002;179:1429-1435 https://doi.org/10.2214/ajr.179.6.1791429
  8. Chong HC, Chai FY, Balakrishnan D, Asilah SM, Adila IN, Syibrah KZ. Malrotated subhepatic caecum with subhepatic appendicitis: diagnosis and management. Case Rep Surg 2016;2016:6067374
  9. Oh JS, Kim KW, Cho HJ. Left-sided appendicitis in a patient with situs inversus totalis. J Korean Surg Soc 2012;83:175-178 https://doi.org/10.4174/jkss.2012.83.3.175
  10. Tabbara F, Ataya KW, Annous Y, Alamiddine K, Zaghal A. Complicated acute appendicitis in a child with left atrial isomerism: a case report. Ann Pediatr Surg 2021;17:21
  11. Ryerson LM, Pharis S, Pockett C, Soni R, Fruitman D, Guleserian KJ, et al. Heterotaxy syndrome and intestinal rotation abnormalities. Pediatrics 2018;142:e20174267
  12. Ku YM, Lee SL, Kim Y, Won Y. Extraperitoneal ascending appendicitis: usefulness of the split interfascial plane sign on MDCT. Diagn Interv Imaging 2016;97:667-672 https://doi.org/10.1016/j.diii.2015.10.004
  13. Lee SL, Ku YM, Rha SE. Comprehensive reviews of the interfascial plane of the retroperitoneum: normal anatomy and pathologic entities. Emerg Radiol 2010;17:3-11 https://doi.org/10.1007/s10140-009-0809-7
  14. Shaban Y, Elkbuli A, McKenney M, Boneva D. Amyand's hernia: a case report and review of the literature. Int J Surg Case Rep 2018;47:92-96 https://doi.org/10.1016/j.ijscr.2018.04.034
  15. Davison AM, Lazda EJ. Small bowel perforation and fatal peritonitis following a fall in a 21-month-old child. Forensic Sci Med Pathol 2008;4:250-254 https://doi.org/10.1007/s12024-008-9041-0
  16. Ufuk F, Herek D, Karabulut N. Pylephlebitis complicating acute appendicitis: prompt diagnosis with contrast-enhanced computed tomography. J Emerg Med 2016;50:e147-e149 https://doi.org/10.1016/j.jemermed.2015.06.083
  17. Ayers BC, Weinberg GA, Caserta M, Kauffman A, Wakeman D. Pyogenic liver abscess following perforated appendicitis. J Pediatr Surg Case Rep 2019;44:101196
  18. Rosat A, Perez E, Sanchez JM, Gonzalez OBH, Barrera M. Vesico-appendiceal fistula secondary to adenocarcinoma of the appendix: a case report and literature review. Pan Afr Med J 2020;37:97
  19. Chung CW, Kim KA, Chung JS, Park DS, Hong JY, Hong YK. Laparoscopic treatment of appendicovesical fistula. Yonsei Med J 2010;51:463-465 https://doi.org/10.3349/ymj.2010.51.3.463
  20. Pickhardt PJ, Levy AD, Rohrmann CA Jr, Kende AI. Primary neoplasms of the appendix: radiologic spectrum of disease with pathologic correlation. Radiographics 2003;23:645-662 https://doi.org/10.1148/rg.233025134
  21. Carr NJ, Bibeau F, Bradley RF, Dartigues P, Feakins RM, Geisinger KR, et al. The histopathological classification, diagnosis and differential diagnosis of mucinous appendiceal neoplasms, appendiceal adenocarcinomas and pseudomyxoma peritonei. Histopathology 2017;71:847-858 https://doi.org/10.1111/his.13324
  22. Leonards LM, Pahwa A, Patel MK, Petersen J, Nguyen MJ, Jude CM. Neoplasms of the appendix: pictorial review with clinical and pathologic correlation. Radiographics 2017;37:1059-1083 https://doi.org/10.1148/rg.2017160150
  23. Fonseca C, Carvalho S, Cunha TM, Gil RT, Abecasis N. The many faces of pseudomyxoma peritonei: a radiological review based on 30 cases. Radiol Bras 2019;52:372-377 https://doi.org/10.1590/0100-3984.2019.0044
  24. Eriguchi N, Matsunaga A, Futamata Y, Tayama K, Harada H, Tanaka A, et al. Appendicitis caused by caecal carcinoma: report of a case. Kurume Med J 2002;49:217-219 https://doi.org/10.2739/kurumemedj.49.217
  25. Majumdar K, Sakhuja P, Kaur S, Rastogi A, Gondal R, Agarwal A. Inflammatory myofibroblastic tumor appendix with concomitant mucosal dysplasia, simulating pseudomyxoma on preoperative aspiration cytology. J Cancer Res Ther 2012;8:317-319 https://doi.org/10.4103/0973-1482.99004
  26. Tirumani SH, Fraser-Hill M, Auer R, Shabana W, Walsh C, Lee F, et al. Mucinous neoplasms of the appendix: a current comprehensive clinicopathologic and imaging review. Cancer Imaging 2013;13:14-25 https://doi.org/10.1102/1470-7330.2013.0003
  27. Agha FP, Ghahremani GG, Panella JS, Kaufman MW. Appendicitis as the initial manifestation of Crohn's disease: radiologic features and prognosis. AJR Am J Roentgenol 1987;149:515-518 https://doi.org/10.2214/ajr.149.3.515
  28. Guglielmo FF, Anupindi SA, Fletcher JG, Al-Hawary MM, Dillman JR, Grand DJ, et al. Small bowel Crohn disease at CT and MR enterography: imaging atlas and glossary of terms. Radiographics 2020;40:354-375 https://doi.org/10.1148/rg.2020190091
  29. Shaoul R, Rimar Y, Toubi A, Mogilner J, Polak R, Jaffe M. Crohn's disease and recurrent appendicitis: a case report. World J Gastroenterol 2005;11:6891-6893 https://doi.org/10.3748/wjg.v11.i43.6891
  30. Westrom L, Joesoef R, Reynolds G, Hagdu A, Thompson SE. Pelvic inflammatory disease and fertility. A cohort study of 1,844 women with laparoscopically verified disease and 657 control women with normal laparoscopic results. Sex Transm Dis 1992;19:185-192 https://doi.org/10.1097/00007435-199207000-00001
  31. El Hentour K, Millet I, Pages-Bouic E, Curros-Doyon F, Molinari N, Taourel P. How to differentiate acute pelvic inflammatory disease from acute appendicitis ? A decision tree based on CT findings. Eur Radiol 2018;28:673-682 https://doi.org/10.1007/s00330-017-5032-4
  32. Sibileau E, Boulay-Coletta I, Julles MC, Benadjaoud S, Oberlin O, Zins M. Appendicitis and diverticulitis of the colon: misleading forms. Diagn Interv Imaging 2013;94:771-792 https://doi.org/10.1016/j.diii.2013.03.009
  33. Abdullgaffar B. Diverticulosis and diverticulitis of the appendix. Int J Surg Pathol 2009;17:231-237 https://doi.org/10.1177/1066896909332728
  34. Sohn TJ, Chang YS, Kang JH, Kim DH, Lee TS, Han JK, et al. Clinical characteristics of acute appendiceal diverticulitis. J Korean Surg Soc 2013;84:33-37 https://doi.org/10.4174/jkss.2013.84.1.33
  35. Lee KH, Lee HS, Park SH, Bajpai V, Choi YS, Kang SB, et al. Appendiceal diverticulitis: diagnosis and differentiation from usual acute appendicitis using computed tomography. J Comput Assist Tomogr 2007;31:763-769 https://doi.org/10.1097/RCT.0b013e3180340991
  36. Kim HS, Kang WK, Chung DJ. Appendiceal immunoglobulin G4-related disease mimicking appendiceal tumor or appendicitis: a case report. Korean J Radiol 2016;17:56-58 https://doi.org/10.3348/kjr.2016.17.1.56