0:01

So the other common mass that affects

0:02

the appendix itself is carcinoid.

0:05

And the literature says that approximately 85%

0:07

of all appendix tumors are carcinoids.

0:11

Also noting that it is the most common location

0:13

for carcinoids to occur, and that's about 60%.

0:16

percent of them occur in the appendix itself.

0:18

In my experience, these are usually

0:20

incidentally found on surgery, and

0:21

they're not usually an imaging diagnosis.

0:24

Uh, these can present as an acute

0:26

appendicitis that may be the cause of

0:28

it, or may just be incidentally present.

0:30

They may be within a mucosal, and they can

0:33

occasionally present as focal thickening.

0:34

Usually again you won't see this on the

0:36

CT scan itself unless you are doing a

0:38

somatostatin PET because they're concerned for

0:41

a carcinoid or some other type of tumor.

0:44

But in this case we could see when we have

0:46

oral contrast on board in this CT scan.

0:49

If you look down here in the appendix you

0:50

have a little bit of thickening right here.

0:53

And this is where the cecum and the

0:55

appendix meet; in this case, it is

0:57

filled with a little bit of contrast

0:58

right here, which is not unusual.

1:00

In fact, it's expected if

1:01

you give oral contrast.

1:03

Nice normal appendix right here.

1:05

And then all of a sudden, it thickens right

1:07

here, and there's no contrast in that area.

1:10

As we get out here towards the tip,

1:13

we don't see any contrast.

1:14

So you have this thickened area here.

1:15

And again, if you're not sure, what

1:16

you're seeing right here, is that real?

1:18

Is that artifact?

1:19

Is it volume averaging?

1:21

Use your additional sequences.

1:22

So here you look at the correct construction.

1:26

And as you edge back here, here's

1:28

your appendix again coming out right

1:29

here, this nice little thin structure.

1:31

And it dilates up here.

1:32

Maybe a little bit inflamed right here.

1:34

You could argue, is this a tip appendicitis?

1:36

But it's so thickened right here that I

1:38

would suspect a mass at this location.

1:41

And they did take this person to the OR,

1:42

and it did end up being a carcinoid.

1:45

So things to remember in this particular

1:47

case: if you are going to see a carcinoid of

1:50

the appendix on a regular CT scan, most often

1:55

they occur at the tip, as in this location.

1:57

A bit rounded, as this one arguably does.

2:00

They can measure up to 2.5 centimeters,

2:01

though again, I'll say that's pretty unusual,

2:03

and they're usually solitary.

2:06

And for whatever reason, they don't

2:08

metastasize very often, much less more

2:10

common than other GI primary sites where

2:13

they can occur, which would be, you know,

2:14

to the mesentery, to the liver, etc.

2:17

These tend to just kind of live there

2:19

at the appendix, and patients actually

2:20

do pretty well after these surgeries.

2:23

Also important to note that carcinoid

2:24

syndrome from these is rare.

2:26

So they often are asymptomatic, which is

2:28

why these are usually caught incidentally,

2:30

um, in surgery for other reasons.

2:32

And these don't cause a mesenteric

2:35

fibrotic-like reaction that you

2:36

see in those mesenteric carcinoids.

2:38

They kind of just sit here and are

2:40

until the surgeon takes them out.