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So the most common abnormality that we see

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with the appendix is acute appendicitis.

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Patients often present with right lower

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quadrant pain, fever, and pain may start at the

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umbilicus and move to the right lower quadrant.

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And they'll often have an elevated white count.

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And what acute appendicitis is, is

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it's an acute obstruction of the lumen.

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What happens is the appendix

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continues to secrete mucus.

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This causes increased pressure

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in the appendix, which dilates.

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This pressure then impairs the venous drainage

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and it can result in mucosal ulceration,

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and then you can get bacterial infection

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because the appendix, of course, is attached

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to the cecum where there's stool present.

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So what you can look for again,

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you follow that colon down.

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So up here, we have the hepatic flexure,

0:44

you follow it down, we have the ascending colon,

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cecum, you have your ileocecal valve right here,

0:49

there's your terminal ileum coming off, which

0:51

looks normal, and then you have this thickening

0:53

here, you have this inflamed appendix.

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It's hyper-enhancing.

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It's dilated.

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If you measure this, it would

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be greater than six millimeters.

1:01

And then, most importantly, you have

1:02

inflammation surrounding the appendix.

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This is the "itis" of acute appendicitis.

1:08

We should note that most perforations are

1:09

walled off because it is an obstructive

1:11

process that causes acute appendicitis.

1:14

You don't usually have free air

1:16

because the air is trapped in the colon where

1:18

it should be, as opposed to in the appendix.

1:20

So it is uncommon to have free

1:22

air, although of course you can.

1:26

Here's the same case on coronal imaging.

1:27

We start right here with the fatty valve

1:29

so that you can figure out where the TI is.

1:32

A few slices down.

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Here is your appendix coming

1:35

right off of the cecum.

1:37

Hyper-enhancing, thick wall.

1:39

It's dilated greater than six millimeters.

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Then the inflammation surrounds it.

1:44

Sometimes it can even almost layer here

1:45

on the fascial lines here, and that's how

1:47

you know it's coming from the appendix

1:48

and not from the terminal ileum, or the

1:50

cecum, or the colon, or some other "itis."