This 18 y/o female presented to the ER with right lower quadrant pain and WBC 15,000 /mm³. Selected images from her abdomino-pelvic CT with rectal contrast shown above do not demonstrate any abnormality. If you mistook her right ovary for an enlarged appendix you are not alone. Her clinical findings the following day led her surgeon to perform an appendectomy, confirming a normal appendix. For the many of you who submitted appendicitis as the diagnosis you can redeem yourselves with the new case this week. Hint - it isn't normal, but might not be appendicitis. You should consider reviewing the literature referenced below before submitting a differential diagnosis on this week's new case, as "it ain't a slam dunk" as they say. ;-)
  1. Birnbaum BA, Wilson SR. Appendicitis at the millennium. Radiology 2000 May;215(2):337-48 UI:20256971
  2. Rao PM. Cecal apical changes with appendicitis: diagnosing appendicitis when the appendix is borderline abnormal or not seen. J Comput Assist Tomogr 1999 Jan-Feb;23(1):55-9 UI:99158095
  3. Urban BA, Fishman EK. Targeted helical CT of the acute abdomen: appendicitis, diverticulitis, and small bowel obstruction. Semin Ultrasound CT MR 2000 Feb;21(1):20-39 UI:20150773
  4. Rowling SE, Jacobs JE, Birnbaum BA. Thin-section CT imaging of patients suspected of having appendicitis or diverticulitis. Acad Radiol 2000 Jan;7(1):48-60 UI:20110054
  5. Hardin DM Jr. Acute appendicitis: review and update. Am Fam Physician 1999 Nov 1;60(7):2027-34 UI:20034793
  6. Rao PM, Rhea JT, Novelline RA. Helical CT of appendicitis and diverticulitis. Radiol Clin North Am 1999 Sep;37(5):895-910 UI:99424064
  7. Birnbaum BA; Jeffrey RB Jr. CT and sonographic evaluation of acute right lower quadrant abdominal pain. AJR Am J Roentgenol 1998 Feb;170(2):361-71 UI:98118063
  8. Rao PM; Rhea JT; Novelline RA; McCabe CJ; et al. Helical CT technique for the diagnosis of appendicitis: prospective evaluation of a focused appendix CT examination Radiology 1997 Jan;202(1):139-44 UI:97141953
    Comment in: Radiology 1997 Jan;202(1):20-1
  9. Federle MP Focused appendix CT technique: a commentary [editorial; comment] Radiology 1997 Jan;202(1):20-1 UI:97141934
    Comment on: Radiology 1997 Jan;202(1):139-44;
    Comment on: Radiology 1997 Jan;202(1):145-9
  10. Rhea JT; Rao PM; Novelline RA; McCabe CJ. A focused appendiceal CT technique to reduce the cost of caring for patients with clinically suspected appendicitis. AJR Am J Roentgenol 1997 Jul;169(1):113-8 UI:97351227
  11. Rao PM; Rhea JT; Novelline RA; Mostafavi AA; McCabe CJ. Effect of computed tomography of the appendix on treatment of patients and use of hospital resources.N Engl J Med 1998 Jan 15;338(3):141-6 UI:98080361
    Comment in: N Engl J Med 1998 Jan 15;338(3):190-1
  12. McColl I. More precision in diagnosing appendicitis [editorial; comment] N Engl J Med 1998 Jan 15;338(3):190-1 UI:98080369
    Comment on: N Engl J Med 1998 Jan 15;338(3):141-6
  13. Rao PM; Rhea JT; Novelline RA; Mostafavi AA; et al. Helical CT combined with contrast material administered only through the colon for imaging of suspected appendicitis. AJR Am J Roentgenol 1997 Nov;169(5):1275-80 UI:98014768
  14. Lane MJ; Katz DS; Ross BA; Clautice-Engle TL; et al. Unenhanced helical CT for suspected acute appendicitis. AJR Am J Roentgenol 1997 Feb;168(2):405-9 UI:97168623
  15. Ghiatas AA; Chopra S; Chintapalli KN; Esola CC; et al. Computed tomography of the normal appendix and acute appendicitis. Eur Radiol 1997;7(7):1043-7 UI:97412201
  16. Hulett R. Imaging of appendicitis. West J Med 1996 Jul-Aug;165(1-2):54-5 UI:97008571
  17. Curtin KR; Fitzgerald SW; Nemcek AA Jr; Hoff FL; Vogelzang RL. CT diagnosis of acute appendicitis: imaging findings. AJR Am J Roentgenol 1995 Apr;164(4):905-9 UI:95243106
  18. Balthazar EJ; Gordon RB. CT of appendicitis. Semin Ultrasound CT MR 1989 Aug;10(4):326-40 UI:90181049
  19. Rao PM; Rhea JT; Novelline RA. Sensitivity and specificity of the individual CT signs of appendicitis: experience with 200 helical appendiceal CT examinations. J Comput Assist Tomogr 1997 Sep-Oct;21(5):686-92 UI:97440246
  20. Rao PM; Wittenberg J; McDowell RK; Rhea JT; Novelline RA. Appendicitis: use of arrowhead sign for diagnosis at CT. Radiology 1997 Feb;202(2):363-6 UI:97167369

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