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Primary neoplasms of the appendix manifesting as acute appendicitis: CT findings with pathologic comparison
Perry J Pickhardt1, Angela D Levy, Charles A Rohrmann
1Department of Radiology, National Naval Medical Center, 8901 Wisconsin Ave, Bethesda, MD 20889-5600, USA. pjpik@hotmail.com
Purpose:
To evaluate the computed tomographic (CT) findings in patients with acute appendicitis related to an underlying appendiceal neoplasm.
Materials And Methods:
Clinical and pathologic data obtained over a 10-year period in 65 patients with primary appendiceal neoplasms were reviewed. Preoperative CT studies in patients who presented clinically with symptoms of acute appendicitis were analyzed retrospectively and in consensus by three radiologists. The appendix was evaluated on CT scans for morphology, location, presence of calcification, maximal diameter, and wall thickness.
Results:
Twenty-six (40%) of the 65 patients with appendiceal neoplasms had presented with symptoms of acute appendicitis. Preoperative CT studies available in 22 patients showed increased appendiceal diameter, wall thickening, and periappendiceal fat stranding in 22 (100%), 22 (100%), and 21 (95%) patients, respectively. The appendiceal diameter was greater than 15 mm (mean diameter, 2.9 cm) in 19 patients (86%). Morphologic changes of concern for neoplasm were present in 19 patients (86%) and included cystic dilatation in nine patients and presence of a soft-tissue mass without dilatation in 10 patients. An appendiceal diameter greater than 15 mm and/or a morphologic abnormality were present in 21 of 22 cases (95%).
Conclusion:
CT findings strongly suggest the presence of underlying neoplasm in the majority of patients with secondary appendicitis.