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Differentiation of Perforated from Nonperforated Appendicitis at CT¹

¹ From the Department of Radiology, Albert Einstein Medical Center, 5501 Old York Rd, Philadelphia, PA 19141 (M.M.H., D.S.W.); and Department of Anesthesiology, Drexel University College of Medicine, Philadelphia, Pa (J.C.H.). From the 2001 RSNA scientific assembly. Received March 7, 2002; revision requested April 26; final revision received July 19; accepted August 17. Address correspondence to M.M.H. (e-mail: horrowm@einstein.edu).

View larger version (151K): [in a new window]   Figure 1a. Transverse CT images obtained with oral and intravenous contrast medium in a 14-year-old girl with perforated appendicitis. (a) CT image demonstrates a 17-mm appendix (arrow) with an intraluminal air-fluid level and a surrounding abscess (A). The enhancing appendiceal wall is intact at this level. (b) CT image obtained more inferiorly demonstrates a break in the enhancing wall (arrows) and extraluminal air.

View larger version (161K): [in a new window]   Figure 1b. Transverse CT images obtained with oral and intravenous contrast medium in a 14-year-old girl with perforated appendicitis. (a) CT image demonstrates a 17-mm appendix (arrow) with an intraluminal air-fluid level and a surrounding abscess (A). The enhancing appendiceal wall is intact at this level. (b) CT image obtained more inferiorly demonstrates a break in the enhancing wall (arrows) and extraluminal air.

View larger version (165K): [in a new window]   Figure 2a. Transverse CT images obtained with oral and intravenous contrast medium in a 50-year-old woman with perforated appendicitis. (a) CT image demonstrates a 13-mm appendix with an intact, enhancing wall (arrow) and an adjacent phlegmon (P). (b) CT image obtained just inferiorly demonstrates a defect in the enhancing appendiceal wall (arrow) and the adjacent phlegmon (P).

View larger version (164K): [in a new window]   Figure 2b. Transverse CT images obtained with oral and intravenous contrast medium in a 50-year-old woman with perforated appendicitis. (a) CT image demonstrates a 13-mm appendix with an intact, enhancing wall (arrow) and an adjacent phlegmon (P). (b) CT image obtained just inferiorly demonstrates a defect in the enhancing appendiceal wall (arrow) and the adjacent phlegmon (P).

View larger version (156K): [in a new window]   Figure 3. Transverse CT image obtained with oral and intravenous contrast medium in a 46-year-old man with perforated appendicitis. Image demonstrates an appendicolith (arrow) almost extruded through the enhancing appendiceal wall.