Computed tomography (CT) findings of a diagnostic dilemma : atypically located acute appendicitis

2016
journal article
article
14
dc.abstract.enBACKGROUND: Acute appendicitis is an emergent surgically treated disease generally represented by right lower abdominal pain. The most common location of the appendix is descending intraperitoneal. However, it can also show atypical locations such as inguinal canal, femoral canal, subhepatic, retrocecal, intraperitoneal abdominal midline and left side in situs inversus or intestinal malrotation patients. Atypical location can lead to atypical clinical presentations. Ultrasonography is the first choice modality for imaging. However, it can be insufficient for demonstration of the appendix. Therefore, computed tomography (CT) is needed for further examination. We aim to review the CT findings of atypically located acute appendicitis with cases and remind the clinicians and radiologists the importance of the prompt diagnosis. CASE REPORT: We presented five atypically-located appendix cases, including four with acute appendicitis that presented to our emergency department with acute abdominal pain. Two of the acute appendicitis cases had normal, the other two had elevated white blood cell count, but all of them had elevated CRP. Ultrasonography imaging was performed as a first-line imaging modality. Because of the inconclusive results of both clinical-laboratory findings and ultrasonography, CT imaging was performed. Abdominal CT demonstrated all of the atypically localised appendices successfully, which were left-sided in a malrotated patient, retrocecal, subhepatic, retrocecal ascending, intraperitoneal abdominal midline localised. CONCLUSIONS: Atypically located acute appendicitis can show atypical presentation and result in misdiagnosis. If ultrasonograpgy is inconclusive, we suggest abdominal CT in such confusing, complicated cases, because misdiagnosis or delay in the right diagnosis can result in complications and increased morbidity and mortality rates.pl
dc.contributor.authorEvrimler, Sehnazpl
dc.contributor.authorOkumuser, Irfanpl
dc.contributor.authorUnal, Nerminpl
dc.date.accessioned2017-05-10T10:33:44Z
dc.date.available2017-05-10T10:33:44Z
dc.date.issued2016pl
dc.date.openaccess0
dc.description.accesstimew momencie opublikowania
dc.description.additionalBibliogr. s. 588pl
dc.description.physical583-588pl
dc.description.versionostateczna wersja wydawcy
dc.description.volume81pl
dc.identifier.doi10.12659/PJR.898880pl
dc.identifier.eissn1899-0967pl
dc.identifier.issn1733-134Xpl
dc.identifier.urihttp://ruj.uj.edu.pl/xmlui/handle/item/40374
dc.languageengpl
dc.language.containerengpl
dc.rightsUdzielam licencji. Uznanie autorstwa - Użycie niekomercyjne - Bez utworów zależnych 3.0 Polska*
dc.rights.licenceCC-BY-NC-ND
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/3.0/pl/legalcode*
dc.share.typeotwarte czasopismo
dc.subject.enabdomenpl
dc.subject.enacutepl
dc.subject.enappendicitispl
dc.subject.enmultidetector computed tomographypl
dc.subtypeArticlepl
dc.titleComputed tomography (CT) findings of a diagnostic dilemma : atypically located acute appendicitispl
dc.title.journalPolish Journal of Radiologypl
dc.typeJournalArticlepl
dspace.entity.typePublication
dc.abstract.enpl
BACKGROUND: Acute appendicitis is an emergent surgically treated disease generally represented by right lower abdominal pain. The most common location of the appendix is descending intraperitoneal. However, it can also show atypical locations such as inguinal canal, femoral canal, subhepatic, retrocecal, intraperitoneal abdominal midline and left side in situs inversus or intestinal malrotation patients. Atypical location can lead to atypical clinical presentations. Ultrasonography is the first choice modality for imaging. However, it can be insufficient for demonstration of the appendix. Therefore, computed tomography (CT) is needed for further examination. We aim to review the CT findings of atypically located acute appendicitis with cases and remind the clinicians and radiologists the importance of the prompt diagnosis. CASE REPORT: We presented five atypically-located appendix cases, including four with acute appendicitis that presented to our emergency department with acute abdominal pain. Two of the acute appendicitis cases had normal, the other two had elevated white blood cell count, but all of them had elevated CRP. Ultrasonography imaging was performed as a first-line imaging modality. Because of the inconclusive results of both clinical-laboratory findings and ultrasonography, CT imaging was performed. Abdominal CT demonstrated all of the atypically localised appendices successfully, which were left-sided in a malrotated patient, retrocecal, subhepatic, retrocecal ascending, intraperitoneal abdominal midline localised. CONCLUSIONS: Atypically located acute appendicitis can show atypical presentation and result in misdiagnosis. If ultrasonograpgy is inconclusive, we suggest abdominal CT in such confusing, complicated cases, because misdiagnosis or delay in the right diagnosis can result in complications and increased morbidity and mortality rates.
dc.contributor.authorpl
Evrimler, Sehnaz
dc.contributor.authorpl
Okumuser, Irfan
dc.contributor.authorpl
Unal, Nermin
dc.date.accessioned
2017-05-10T10:33:44Z
dc.date.available
2017-05-10T10:33:44Z
dc.date.issuedpl
2016
dc.date.openaccess
0
dc.description.accesstime
w momencie opublikowania
dc.description.additionalpl
Bibliogr. s. 588
dc.description.physicalpl
583-588
dc.description.version
ostateczna wersja wydawcy
dc.description.volumepl
81
dc.identifier.doipl
10.12659/PJR.898880
dc.identifier.eissnpl
1899-0967
dc.identifier.issnpl
1733-134X
dc.identifier.uri
http://ruj.uj.edu.pl/xmlui/handle/item/40374
dc.languagepl
eng
dc.language.containerpl
eng
dc.rights*
Udzielam licencji. Uznanie autorstwa - Użycie niekomercyjne - Bez utworów zależnych 3.0 Polska
dc.rights.licence
CC-BY-NC-ND
dc.rights.uri*
http://creativecommons.org/licenses/by-nc-nd/3.0/pl/legalcode
dc.share.type
otwarte czasopismo
dc.subject.enpl
abdomen
dc.subject.enpl
acute
dc.subject.enpl
appendicitis
dc.subject.enpl
multidetector computed tomography
dc.subtypepl
Article
dc.titlepl
Computed tomography (CT) findings of a diagnostic dilemma : atypically located acute appendicitis
dc.title.journalpl
Polish Journal of Radiology
dc.typepl
JournalArticle
dspace.entity.type
Publication
Affiliations

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