This 15 y/o female presented with a 3 day history of lower abdominal pain. On exam there was lower abdominal tenderness without rebound, T - 99.2° F, WBC - 9,500 /cc³. Abdominal and pelvic ultrasound exams were normal. A spiral CT with rectal contrast was performed. Selected images shown above demonstrate thickening of the cecal wall secondary to inflammatory changes from appendicitis, forming a so-called "arrowhead" sign. Considering the institutional source of this "sign", it's surprising that a more novel, innovative name wasn't used.
  1. 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
  2. Birnbaum BA, Wilson SR. Appendicitis at the millennium. Radiology 2000 May;215(2):337-48 UI:20256971
  3. 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
  4. 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
  5. 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
  6. Hardin DM Jr. Acute appendicitis: review and update. Am Fam Physician 1999 Nov 1;60(7):2027-34 UI:20034793
  7. Rao PM, Rhea JT, Novelline RA. Helical CT of appendicitis and diverticulitis. Radiol Clin North Am 1999 Sep;37(5):895-910 UI:99424064
  8. Sivit CJ. Imaging children with acute right lower quadrant pain. Pediatr Clin North Am 1997 Jun;44(3):575-89 UI:97312428
  9. 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
  10. Lane MJ, Mindelzun RE. Appendicitis and its mimickers. Semin Ultrasound CT MR 1999 Apr;20(2):77-85 UI:99239022
  11. Rao PM, Boland GW. Imaging of acute right lower abdominal quadrant pain. Clin Radiol 1998 Sep;53(9):639-49 UI:98438107
    Comment in: Clin Radiol 1999 Apr;54(4):271
  12. 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

Use the Back or Backward button on your browser to return