Wk 3, Case 3 - Review

EXAM: US Appendix

INDICATION: Right lower quadrant tenderness and pain for 2 days.

TECHNIQUE: Ultrasound imaging of the right lower quadrant of the abdomen was performed using two-dimensional grayscale imaging. Color Doppler images were obtained to evaluate vascular flow. The exam was performed to evaluate for appendicitis.

FINDINGS:

Any Limitations: None.

Appendix visualization: The appendix is clearly visualized, and the maximum outer diameter is 14 mm (normal is typically < 7 mm).

There is appendiceal wall hyperemia and echogenic surrounding fat. An appendicolith is visualized. The appendix is not compressible.

There is free fluid adjacent to the appendix. There is no loculated fluid collection visualized.

The incidentally seen right kidney is normal.

IMPRESSIONS:

Findings are consistent with appendicitis. No abscess visualized.

EXAM: CT Abdomen and Pelvis W/ IV Contrast

INDICATION: Female with right-sided abdominal pain and vomiting for 2 days.

TECHNIQUE: CT imaging of the abdomen and pelvis was obtained with IV contrast. Routine protocol was utilized. Coronal and sagittal reformats were obtained.

FINDINGS:

The lung bases are clear. There is no pleural effusion. Visualized portions of the mediastinum are normal.

In the abdomen, the liver is of normal size and the parenchyma is without focal lesions. There is no intra- or extrahepatic biliary ductal dilatation. The gallbladder is without wall thickening, calcified gallstones, or pericholecystic fluid. The pancreas demonstrates uniform enhancement without inflammatory changes. The spleen is normal in size without focal lesion. The adrenal glands are normal in appearance.

The kidneys demonstrate normal enhancement without focal cystic or solid lesion. No hydronephrosis or hydroureter. The urinary bladder is normal in appearance. The visualized reproductive organs are normal for patient's age.

The bowel is normal in caliber without wall thickening. There is no evidence of obstruction.

The appendix is abnormally dilated measuring 1.4 cm. An appendicolith is present. There are surrounding inflammatory changes. No focal fluid collection is seen. There are no pathologically enlarged lymph nodes. There is a trace amount of free pelvic fluid, but no focal fluid collection.

There is a normal appearance of the aorta and its major branches, and a normal appearance of the IVC.

The abdominal wall soft tissues are normal. There are no acute bony abnormalities.

IMPRESSIONS:

1. Acute, uncomplicated appendicitis with an appendicolith present.
2. No abscess