PERBEDAAN APPENDICITIS AKUT, APPENDICITIS

INFILTRAT DAN ABSES APPENDISITIS

PADA USG DAN CT SCAN
Oleh :
Agnes Angelia Anthonius 17014101021
Jessica Giovanni Runtu 17014101262
Angela W.L.C Pangemanan 17014101277

Supervisor Pembimbing :
dr. Ariel E. Mongan, Sp.Rad

BAGIAN RADIOLOGI
FAKULTAS KEDOKTERAN
UNIVERSITAS SAM RATULANGI
MANADO
 APPENDISITIS AKUT
USG
 Noncompressible blind-ending tubular
structure measuring more than 6mm in
diameter.
 Gambaran tidak terkompresi, fixed, struktur
blind-ending tubular yang terdistensi dengan
cairan dan ukuran > 6mm selama kompresi
gradasi.
 Appendicolith mungkin dapat divisualisasi
sebagai echogenic, shadowing foci dalam
lumen appendix.
 Color Doppler dapat menggambarkan
peningkatan vaskularitas dari dinding
appendix yang inflamasi.
 Kekurangan : “operator dependent”,
CT SCAN
 Distended appendix with adjacent
inflammatory changes and thickening of
adjacent cecum (“arrowhead sign”)
 Appendix terlihat membesar, sering dikelilingi
perubahan inflamasi, penebalan fascial, dan
sejumlah kecil cairan intraperitoneal bebas.
 Appendicolith juga dapat terlihat pada CT
Scan.
 Mungkin terlihat edema pada appendix,
sebagai bukti penebalan sekum yang
berdekatan , “arrowhead sign”.
 Uk. appendix >6mm, curiga tanda inflamasi
sekunder.
 Kekurangan : “Ionizing radiation”.
USG

Gambar. 1 Pria berusia tiga puluh satu tahun.

Bagian memanjang dari usus buntu yang
meradang menunjukkan fitur klasik. Perhatikan
apendiks yang membesar (diameter, 9,2 mm)
dengan perubahan inflamasi periappendiceal
USG
USG
USG
USG
USG
Acute appendicitis with a small periappendiceal
abscess. The patient had a 4-day history of right
lower quadrant pain and at physical examination
had clear peritonitis. The sedimentation rate was
48 mm/hour. Palpation was unreliable. Subsequent
appendectomy with evacuation of the abscess was
performed without technical difficulties. 
CT SCAN
CT SCAN
CT SCAN
APPENDISITIS PERFORASI
USG
 Diagnosis appendicitis perforasi
terutama bergantung pada gambaran
abses fossa iliaka kanan atau
phlegmon yang dikaitkan dengan
tanda-tanda inflamasi appendix dan
appendicolith.
CT SCAN
 Sensiivitas dan spesifisitas lebih baik.
 Temuan spesifik :
 Abses periappendiks
 Defek yang terlihat jelas di dinding
apendiks
 Gas ekstraluminal terlokalisasi atau gas
intraperitoneal bebas
 Appendicolith di luar appendix atau abses
di dalam fossa iliaka kanan.
 Kebocoran intraperitoneal kontras dubur.
 Temuan kurang specifik :
 Moderate periappendiceal phlegmon
 Peningkatan defek dinding appendix
USG
 CT SCAN
10 year old girl had been diagnosed with
perforated appendicitis and small adjacent abscess
by ultrasound (for more details, return to 
US case presentation). After seven days of
intravenous antibiotics, her abdominal pain and
fever persisted. A CT examination was obtained for
further evaluation.

Non-contrast enhanced CT image of the pelvis demonstrates

the enlarged, inflamed appendix (small arrows), which contains
an appendicolith (large arrow), protruding into an anterior
abdominal fluid collection representing an abscess (A).
 CT SCAN
Perforated appendicitis with pericecal abscess.7 year
old girl presented to the emergency room with two day
history of right lower quadrant pain, fever, and emesis. A CT
examination was obtained to evaluate for appendicitis,
shown below.

Intravenous contrast-enhanced CT image of

the lower abdomen shows an enhancing
retrocecal mass (A) consistent with an
abscess. There is inflammatory infiltration
(arrows) of the retrocecal fat.
APPENDISITIS INFILTRAT
USG CT SCAN

 Tampak sebagai massa inflamasi  Gas extraluminal (terlokalisasi/

atau terkumpulnya cairan bebas), cairan peritoneal bebas,
complex yang terlokalisasi. terkumpulnya debris nekrotik
fokal dan keterlibatan fokal
dinding appendix.
APPENDISITIS ABSES
USG CT SCAN

 Tampak sebagai massa inflamasi  Periappendiceal abses, gas

atau terkumpulnya cairan extraluminal (terlokalisasi/ bebas),
complex yang terlokalisasi. cairan peritoneal bebas,
terkumpulnya debris nekrotik fokal
 Pengumpulan cairan (hypoechoic) dan keterlibatan fokal dinding
di daerah appendicular yang appendix.
mungkin terbatas dan bulat atau
 Paling jarang ditemukan, udara
tidak jelas dan penampilannya
tidak teratur. bebas di cavitas peritoneal dan
thrombosis vena porta.
 Lebih baik daripada USG dalam
mendiagnosis abses appendicitis.
USG
USG

Appendiceal abscess. Large abscess cavity contains a fecalith.

Note the inflamed appendix ( arrows ) lying next to the
abscess. 
 CT SCAN
Perforated appendicitis with generalized peritonitis and
multiple abscesses.14 year old girl presented with one week history
of nausea, vomiting, and fever. A CT scan was performed to evaluate
for appendicitis, shown below.

Figure 1. Axial CT image in the upper pelvis shows free

intraperitoneal fluid (FF) with enhancement of the peritoneum
(black arrows) consistent with peritonitis. A calcified
appendicolith (white arrow) is present.
 CT SCAN
Perforated appendicitis with generalized peritonitis and
multiple abscesses.14 year old girl presented with one week history
of nausea, vomiting, and fever. A CT scan was performed to evaluate
for appendicitis, shown below.

Figure 2. CT image lower in the pelvis demonstrates loculated

abscess collections (black arrows) posterior to the uterus (U).
Bladder (B) is seen anterior to the uterus.
 CT SCAN
Perforated appendicitis with generalized peritonitis and
multiple abscesses.14 year old girl presented with one week history
of nausea, vomiting, and fever. A CT scan was performed to evaluate
for appendicitis, shown below.

Figure 3. CT image at a similar level as Figure 1, obtained two

weeks later after intravenous antibiotic and fluid therapy,
demonstrates interval increase in size of the infected peritoneal
fluid collection (A). Note the abnormal enhancement and
thickening of the peritoneum (arrow).
 CT SCAN
Perforated appendicitis with multiple abscesses.3 year old girl with abdominal
pain and vomiting for five days was treated at an outside hospital with oral
antibiotics.The patient improved slightly but presented to our emergency room two
days later with similar symptoms and new leukocytosis. A CT scan was performed,
shown below.

Figure 1. CT image of the lower abdomen shows a multi-

loculated fluid collection with enhancing walls consistent with
an abscess (arrows).
 CT SCAN
Perforated appendicitis with multiple abscesses.3 year old girl with abdominal
pain and vomiting for five days was treated at an outside hospital with oral
antibiotics.The patient improved slightly but presented to our emergency room two
days later with similar symptoms and new leukocytosis. A CT scan was performed,
shown below.

Figure 2. Axial CT image at a lower level

than figure 3 shows a pericecal abscess
with thickened walls (arrows).