Routine appendiceal CT performed in patients who present with suspected appendicitis improves patient care and reduces the use of hospital resources.

Appendix CT examination can help diagnose or exclude appendicitis and establish an alternative diagnosis.

On CT, acute epiploic appendagitis has a predictable appearance in terms of location, size, and density. The most common finding on CT is a fat-density oval lesion with surrounding inflammation on the anterior aspect of the sigmoid colon. The changes on CT are not predictable in the 2-week to 6-month window.

Individual appendiceal CT signs of appendicitis vary in sensitivity, specificity, and thus diagnostic value. An enlarged appendix with periappendiceal fat stranding occurs in 93% of appendicitis CT cases. Less common but specific signs [cecal apical changes, appendolith(s) are usually present in the remaining appendicitis cases. Some signs seen with appendicitis (adenopathy, fat stranding, adjacent bowel wall thickening, fluid) can also be noted with alternative conditions, and in these cases normal appendix identification is the key to excluding appendicitis.

Today, a wide range of traumatic and nontraumatic emergency conditions are quickly and accurately diagnosed with helical computed tomography (CT). Many traditional emergency imaging procedures have been replaced with newer helical CT techniques that can be performed in less time and with greater accuracy, less patient discomfort, and decreased cost. The speed of helical technology permits CT examination of seriously ill patients in the emergency department, as well as patients who might not have been taken to CT previously because of the length of the examinations of the past. Also, helical technology permits multiple, sequential CT scans to be quickly obtained in the same patient, a great advance for the multiple-trauma patient. Higher quality CT examinations result from decreased respiratory misregistration, enhanced intravenous contrast material opacification of vascular structures and parenchymal organs, greater flexibility in image reconstruction, and improved multiplanar and three-dimensional reformations. This report summarizes the role and recommended protocols for the helical CT diagnosis of thoracic aortic trauma; aortic dissection; pulmonary embolism; acute conditions of the neck soft tissues; abdominal trauma; urinary tract stones; appendicitis; diverticulitis; abdominal aortic aneurysm; fractures of the face, spine, and extremities; and acute stroke.