DISTAL APPENDICITIS - CT APPEARANCE AND DIAGNOSIS

PURPOSE: To determine the appearance of appendicitis in the distal par t of the organ (distal appendicitis) on computed tomographic (CT) scan s and to evaluate the accuracy of diagnosis based on CT findings. MATE RIALS AND METHODS: CT scans and medical records in 180 consecutive pat ients with proved appendicitis were reviewed. Fourteen had distal appe ndicitis with at least a 3-cm length of normal proximal appendix. Appe ndiceal CT scans and initial reports were reviewed retrospectively. RE SULTS: The proximal appendix was collapsed (n = 6) or was filled with contrast material (n = 6) or air (n = 2). Inflamed distal appendices a veraged 13.2 mm in diameter and were associated with periappendiceal f at stranding (n = 14), adenopathy (n = 6), appendolith(s) (n = 4), or fluid (n = 2). Transition points consisted of a progressively narrowed appendiceal lumen and thickened wall (n = 5) or appendiceal diameter enlargement (n = 9). No cecal apical changes were seen. Scans in all 1 4 patients were prospectively interpreted as indicative of appendiciti s, including 12 (86%) interpreted as indicative of distal appendicitis . CONCLUSION: CT findings are useful for the accurate diagnosis of dis tal appendicitis. Visualization of the proximal appendix alone is insu fficient to exclude distal appendicitis.