Acute appendicitis in adults: CT features

Acute appendicitis is the most common cause of abdominal surgery. For years, the diagnosis of acute appendicitis has mainly relied on the physical examination with a tendency to operate in doubt. Currently, the CT scan has become a major element for deciding on the appropriate management of suspected acute appendicitis in adults. The CT technique must be rigorous, with acquisition of thin sections for 3D reconstructions and an intravenous injection of iodinated contrast. An enema is optional. The interpretation is based on the association of appendicular signs: wall thickening of the appendix increase, in appendiceal caliber and contrast enhancement of the abnormal appendix wall with periappendicular signs that reflect the consequences of inflammation and changes in cecum secondary to acute appendicitis, mainly characterized by an asymmetrical thickening of the cecum. The CT scan is of major importance for positive diagnosis of acute appendicitis, but also for the differential diagnosis, which includes mesenteric adenolymphitis, Crohn's disease, cecal diverticulitis, colopathies, appendagitis, mental infarction, tubo-ovarian abscess and urolithiasis. At the present time, systematic CT-scan is the cost-effective approach for the management of appendicular syndromes. (C) 2010 Elsevier Masson SAS. All rights reserved.