{"id":26404,"date":"2022-12-09T21:55:34","date_gmt":"2022-12-10T02:55:34","guid":{"rendered":"https:\/\/www.stepwards.com\/?page_id=26404"},"modified":"2025-03-21T21:11:43","modified_gmt":"2025-03-22T01:11:43","slug":"abdominal-imaging-call-prep-cases-appendicitis-comp","status":"publish","type":"page","link":"https:\/\/www.stepwards.com\/?page_id=26404","title":{"rendered":"Abdominal Imaging Call Prep Cases: A\u200bp\u200bp\u200be\u200bn\u200bd\u200bi\u200bc\u200bi\u200bt\u200bi\u200bs\u200b \u200bC\u200bo\u200bm\u200bp\u200bl\u200bi\u200bc\u200ba\u200bt\u200be\u200bd\u200b \u200bb\u200by\u200b \u200bA\u200bb\u200bs\u200bc\u200be\u200bs\u200bs\u200b \u200b(\u200bC\u200bT\u200b)"},"content":{"rendered":"<div id=\"toc_container\" class=\"no_bullets\"><p class=\"toc_title\">Page Contents<\/p><ul class=\"toc_list\"><li><a href=\"#OVERVIEW\"><span class=\"toc_number toc_depth_1\">1<\/span> OVERVIEW<\/a><\/li><li><a href=\"#WHAT_IS_IT_EXACTLY\"><span class=\"toc_number toc_depth_1\">2<\/span> WHAT IS IT EXACTLY?<\/a><\/li><li><a href=\"#WHY_IS_IT_AN_IMPORTANT_CALL_CASE\"><span class=\"toc_number toc_depth_1\">3<\/span> WHY IS IT AN IMPORTANT CALL CASE?<\/a><\/li><li><a href=\"#WHAT_CLINICAL_CONTEXT_HELPS_RAISE_SUSPICION_FOR_THIS_DIAGNOSIS\"><span class=\"toc_number toc_depth_1\">4<\/span> WHAT CLINICAL CONTEXT HELPS RAISE SUSPICION FOR THIS DIAGNOSIS?<\/a><\/li><li><a href=\"#WHAT_IS_THE_KEY_TO_MAKING_THIS_DIAGNOSIS_ON_CALL\"><span class=\"toc_number toc_depth_1\">5<\/span> WHAT IS THE KEY TO MAKING THIS DIAGNOSIS ON CALL?<\/a><\/li><li><a href=\"#WHAT_HAPPENS_NEXT_AFTER_THE_DIAGNOSIS_IS_MADE\"><span class=\"toc_number toc_depth_1\">6<\/span> WHAT HAPPENS NEXT AFTER THE DIAGNOSIS IS MADE?<\/a><\/li><li><a href=\"#CASE_ARCHIVE\"><span class=\"toc_number toc_depth_1\">7<\/span> CASE ARCHIVE\u00a0<\/a><\/li><\/ul><\/div>\n<h5><span id=\"OVERVIEW\"><span style=\"text-decoration: underline;\">OVERVIEW<\/span><\/span><\/h5>\n<p>This page is dedicated to covering a very important call case: appendicitis complicated by abscess. This page will specifically cover this diagnosis in the setting of making the finding on abdomen\/pelvis CT imaging.<\/p>\n<figure id=\"attachment_26459\" aria-describedby=\"caption-attachment-26459\" style=\"width: 676px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/www.stepwards.com\/wp-content\/uploads\/2023\/02\/Screen-Shot-2023-02-16-at-1.15.01-PM-scaled.jpg\"><img loading=\"lazy\" class=\" wp-image-26459\" src=\"http:\/\/www.stepwards.com\/wp-content\/uploads\/2023\/02\/Screen-Shot-2023-02-16-at-1.15.01-PM-scaled.jpg\" alt=\"\" width=\"686\" height=\"312\" srcset=\"https:\/\/www.stepwards.com\/wp-content\/uploads\/2023\/02\/Screen-Shot-2023-02-16-at-1.15.01-PM-scaled.jpg 2560w, https:\/\/www.stepwards.com\/wp-content\/uploads\/2023\/02\/Screen-Shot-2023-02-16-at-1.15.01-PM-300x136.jpg 300w, https:\/\/www.stepwards.com\/wp-content\/uploads\/2023\/02\/Screen-Shot-2023-02-16-at-1.15.01-PM-1024x465.jpg 1024w, https:\/\/www.stepwards.com\/wp-content\/uploads\/2023\/02\/Screen-Shot-2023-02-16-at-1.15.01-PM-768x349.jpg 768w, https:\/\/www.stepwards.com\/wp-content\/uploads\/2023\/02\/Screen-Shot-2023-02-16-at-1.15.01-PM-1536x698.jpg 1536w, https:\/\/www.stepwards.com\/wp-content\/uploads\/2023\/02\/Screen-Shot-2023-02-16-at-1.15.01-PM-2048x930.jpg 2048w\" sizes=\"(max-width: 686px) 100vw, 686px\" \/><\/a><figcaption id=\"caption-attachment-26459\" class=\"wp-caption-text\">An axial (screen left) and coronal (screen right) image of a CT abdomen\/pelvis with contrast showing an inflamed appendix with adjacent perforation and a discrete abscess (yellow arrows).<\/figcaption><\/figure>\n<p>Many of the cases presented here will be CT scans of the abdomen\/pelvis with contrast however certain cases may present non-contrast imaging (which can have overlapping findings). This page assumes that you are familiar with <a href=\"https:\/\/www.stepwards.com\/?page_id=26403\">acute uncomplicated appendicitis<\/a> and <a href=\"https:\/\/www.stepwards.com\/?page_id=26405\">perforated appendicitis<\/a> (each of which have a separate linked page).<\/p>\n<h5><span id=\"WHAT_IS_IT_EXACTLY\"><span style=\"text-decoration: underline;\">WHAT IS IT EXACTLY?<\/span><\/span><\/h5>\n<p>Appendicitis complicated by abscess is a fairly self descriptive condition: it is acute appendicitis that has often perforated (sometimes a partially contained perforation), which has resulted in the formation of a discrete fluid collection (abscess).<\/p>\n<h5><span id=\"WHY_IS_IT_AN_IMPORTANT_CALL_CASE\"><span style=\"text-decoration: underline;\">WHY IS IT AN IMPORTANT CALL CASE?<\/span><\/span><\/h5>\n<p>As discussed on the <a href=\"https:\/\/www.stepwards.com\/?page_id=26403\">acute uncomplicated appendicitis<\/a>, appendicitis is generally a condition that has immediate surgical considerations (as many patients get an emergent appendectomy as well as antibiotics).<\/p>\n<p>These considerations get a bit more nuanced in the setting of <a href=\"https:\/\/www.stepwards.com\/?page_id=26405\">perforated appendicitis<\/a>. In the setting of an abscess (with or without the evidence of perforation) percutaneous drainage of the fluid collection becomes a serious consideration (prior to considering surgery).<\/p>\n<h5><span id=\"WHAT_CLINICAL_CONTEXT_HELPS_RAISE_SUSPICION_FOR_THIS_DIAGNOSIS\"><span style=\"text-decoration: underline;\">WHAT CLINICAL CONTEXT HELPS RAISE SUSPICION FOR THIS DIAGNOSIS?<\/span><\/span><\/h5>\n<p>Patients may present in a manner very similar to those that have <a href=\"https:\/\/www.stepwards.com\/?page_id=26403\">acute uncomplicated appendicitis<\/a>. Additionally patients who previously had a known <a href=\"https:\/\/www.stepwards.com\/?page_id=26405\">perforated appendicitis<\/a> that was treated nonoperatively may present again with an abscess.<\/p>\n<h5><span id=\"WHAT_IS_THE_KEY_TO_MAKING_THIS_DIAGNOSIS_ON_CALL\"><span style=\"text-decoration: underline;\">WHAT IS THE KEY TO MAKING THIS DIAGNOSIS ON CALL?<\/span><\/span><\/h5>\n<p>The initial step is to identify if the patient has acute appendicitis which is covered in detail on the separate page on <a href=\"https:\/\/www.stepwards.com\/?page_id=26403\">acute uncomplicated appendicitis.\u00a0<\/a><\/p>\n<p>Onc an appendicitis is identified, it is important to evaluate for clues <a href=\"https:\/\/www.stepwards.com\/?page_id=26405\">to suggest perforation as discussed here<\/a>.<\/p>\n<p style=\"text-align: center;\"><iframe loading=\"lazy\" title=\"YouTube video player\" src=\"https:\/\/www.youtube.com\/embed\/videoseries?list=PLd9O3REk4a33PU9ywJfwwxhqvyNtkG2Og\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p>Additionally clues that might suggest the presence of an abscess should be assessed as well. Mainly the presence of a focal fluid collection really makes this diagnosis.\u00a0 It can be near the appendix, however may also be in a remote location. There can also be more than one!<\/p>\n<h5><span id=\"WHAT_HAPPENS_NEXT_AFTER_THE_DIAGNOSIS_IS_MADE\"><span style=\"text-decoration: underline;\">WHAT HAPPENS NEXT AFTER THE DIAGNOSIS IS MADE?<\/span><\/span><\/h5>\n<p>Once appendicitis with an abscess is identified, the care team will generally assess to see if it can be drained via a percutaneous approach. Then (depending upon this, and a few other clinical variables) the patient will get some combination of antibiotics, percutaneous drainage, surgery (with or without a temporary drain placement).<\/p>\n<h5><span id=\"CASE_ARCHIVE\"><span style=\"text-decoration: underline;\">CASE ARCHIVE\u00a0<\/span><\/span><\/h5>\n<p><strong>Use the following login information to access the case archives: USERNAME: user, PASSWORD: password.<\/strong><\/p>\n<p><a href=\"https:\/\/pacsrad.com:3333\/studyList?album=Call%20Prep%20Cases%3A%20Body%20-%20Appendicitis%20Complicated%20by%20Abscess%20%28CT%29\">Click here to open up a case archive of a\u200bp\u200bp\u200be\u200bn\u200bd\u200bi\u200bc\u200bi\u200bt\u200bi\u200bs\u200b \u200bco\u200bm\u200bp\u200bl\u200bi\u200bc\u200ba\u200bt\u200be\u200bd\u200b \u200bb\u200by\u200b \u200ba\u200bb\u200bs\u200bc\u200be\u200bs\u200bs seen on CT.<\/a><\/p>\n<p>&nbsp;<\/p>\n<p>Page Updated: 02.16.23<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Page Contents1 OVERVIEW2 WHAT IS IT EXACTLY?3 WHY IS IT AN IMPORTANT CALL CASE?4 WHAT CLINICAL CONTEXT HELPS RAISE SUSPICION FOR THIS DIAGNOSIS?5 WHAT IS THE KEY TO MAKING THIS DIAGNOSIS ON CALL?6 WHAT HAPPENS NEXT AFTER THE DIAGNOSIS IS MADE?7 CASE ARCHIVE\u00a0 OVERVIEW This page is dedicated to covering a very important call case: &#8230; <a title=\"Abdominal Imaging Call Prep Cases: A\u200bp\u200bp\u200be\u200bn\u200bd\u200bi\u200bc\u200bi\u200bt\u200bi\u200bs\u200b \u200bC\u200bo\u200bm\u200bp\u200bl\u200bi\u200bc\u200ba\u200bt\u200be\u200bd\u200b \u200bb\u200by\u200b \u200bA\u200bb\u200bs\u200bc\u200be\u200bs\u200bs\u200b \u200b(\u200bC\u200bT\u200b)\" class=\"read-more\" href=\"https:\/\/www.stepwards.com\/?page_id=26404\" aria-label=\"More on Abdominal Imaging Call Prep Cases: A\u200bp\u200bp\u200be\u200bn\u200bd\u200bi\u200bc\u200bi\u200bt\u200bi\u200bs\u200b \u200bC\u200bo\u200bm\u200bp\u200bl\u200bi\u200bc\u200ba\u200bt\u200be\u200bd\u200b \u200bb\u200by\u200b \u200bA\u200bb\u200bs\u200bc\u200be\u200bs\u200bs\u200b \u200b(\u200bC\u200bT\u200b)\">Read more<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":26318,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_mi_skip_tracking":false},"jetpack_shortlink":"https:\/\/wp.me\/P71awf-6RS","_links":{"self":[{"href":"https:\/\/www.stepwards.com\/index.php?rest_route=\/wp\/v2\/pages\/26404"}],"collection":[{"href":"https:\/\/www.stepwards.com\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.stepwards.com\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.stepwards.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.stepwards.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=26404"}],"version-history":[{"count":7,"href":"https:\/\/www.stepwards.com\/index.php?rest_route=\/wp\/v2\/pages\/26404\/revisions"}],"predecessor-version":[{"id":26469,"href":"https:\/\/www.stepwards.com\/index.php?rest_route=\/wp\/v2\/pages\/26404\/revisions\/26469"}],"up":[{"embeddable":true,"href":"https:\/\/www.stepwards.com\/index.php?rest_route=\/wp\/v2\/pages\/26318"}],"wp:attachment":[{"href":"https:\/\/www.stepwards.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=26404"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}