0:00

Okay, so here we go.

0:01

Another contrast-enhanced CT scan of the abdomen.

0:04

You can see the liver is looking, um, homogeneous.

0:07

And the spleen is okay, and the

0:09

pancreas in this case is okay.

0:11

So we are going to clear the pancreas as well.

0:13

Now as we come down, we're going to see that this

0:16

patient actually has right lower quadrant pain,

0:17

and there's already a little bit of fluid in

0:19

the pericolic gutter on the right, even kind of

0:21

coming up into that perihepatic region as well.

0:25

So we know that there's some inflammation

0:27

going on on the right side, and as we come

0:29

down, we'll see the colon here with the cecum,

0:33

all in the right lower quadrant, and then off

0:35

of the cecum we see this whole location of much

0:40

inflammation with a little tiny calcification as well.

0:43

So this is a classic look of appendicitis.

0:46

Let's go on the coronal.

0:47

I think it'll be much more beautiful; here we can

0:50

see the cecum has that really thick-walled cecum.

0:52

It used to be called a coned cecum back in the day.

0:55

Can you believe in history

0:56

radiologists used to diagnose

0:58

appendicitis with contrast

1:01

enemas in the emergency room?

1:02

I mean, we think our life is hard.

1:04

Can you imagine?

1:05

But how they would do that is they would

1:06

actually put contrast through the colon,

1:08

and if they were able to see the appendix

1:10

with contrast, it was considered negative.

1:12

So any appendix that filled with contrast,

1:14

but some of the secondary signs were

1:16

the coned cecum, and that was because you can imagine

1:18

the cecum wouldn't fill with contrast in those cases.

1:21

What we see now on CT scan is just a

1:22

very thickened cecum, and off of the cecum

1:25

we see this blind-ending tube there.

1:27

We have a calcification,

1:28

probably the problem for this patient at the

1:30

base of the appendix causing obstruction.

1:32

That can be called an appendicolith or appendiceal lith.

1:35

Lith.

1:35

I think it's like tomato,

1:36

tomato.

1:37

Either way, this is appendicitis.

1:39

The appendix is enlarged.

1:40

It is dilated.

1:41

There's a lot of stranding and graying

1:44

of the fat adjacent to the appendix,

1:45

and nowhere else.

1:47

So this is appendicitis.

1:48

I don't see any evidence of perforation,

1:50

so I don't see any perforated fluid

1:51

collections or drainable fluid collections.

1:54

I tend to put in my reports: appendicitis,

1:56

no evidence of drainable fluid collection.

1:58

I don't always talk about actual perforation because

2:00

our surgeons aren't the fastest to the knife.

2:03

So sometimes they'll be like, oh, it's perforated,

2:05

and I'm gonna blame them on that, not me.

2:07

So this would be simple appendicitis,

2:10

uncomplicated in this patient.