Beyond Appendicitis: Common and Uncommon Gastrointestinal Causes of Right Lower Quadrant Abdominal Pain at Multidetector CT

Purysko, Andrei S.; Remer, Erick M.; Filho, Hilton Muniz Leão; Bittencourt, Leonardo Kayat; Lima, Rodrigo V.; Racy, Douglas Jorge

doi:10.1148/rg.314105065

Cited by 67 publications

(43 citation statements)

References 64 publications

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“…After a positive diagnosis is made using CT, it is standard procedure for the patient to get a follow up colonoscopy around 6 weeks after being diagnosed [9,95]. This is a preventative measure to ensure that the diagnosis of diverticulitis did not miss a diagnosis of colon cancer [77,82,87,91,[95][96][97]. In a study conducted by Lau et al, 34% of patients' follow up colonoscopies came back positive for further complications or misdiagnosis of the initial diverticulitis [97].…”

Section: Endoscopymentioning

confidence: 99%

“…This is a preventative measure to ensure that the diagnosis of diverticulitis did not miss a diagnosis of colon cancer [77,82,87,91,[95][96][97]. In a study conducted by Lau et al, 34% of patients' follow up colonoscopies came back positive for further complications or misdiagnosis of the initial diverticulitis [97]. While there is nothing to indicate that a positive diagnosis for diverticulitis is correlated with a higher risk for colorectal cancer, it has been observed that patients who present with diverticular complications have been more likely to have a positive colonoscopy for colorectal cancer sometime after the diverticulitis diagnosis [77,97].…”

Section: Endoscopymentioning

confidence: 99%

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Imaging Inflammation and Infection in the Gastrointestinal Tract

Frickenstein

Jones

Behkam

et al. 2019

IJMS

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A variety of seemingly non-specific symptoms manifest within the gastrointestinal (GI) tract, particularly in the colon, in response to inflammation, infection, or a combination thereof. Differentiation between symptom sources can often be achieved using various radiologic studies. Although it is not possible to provide a comprehensive survey of imaging gastrointestinal GI tract infections in a single article, the purpose of this review is to survey several topics on imaging of GI tract inflammation and infections. The review discusses such modalities as computed tomography, positron emission tomography, ultrasound, endoscopy, and magnetic resonance imaging while looking at up-an-coming technologies that could improve diagnoses and patient comfort. The discussion is accomplished through examining a combination of organ-based and organism-based approaches, with accompanying selected case examples. Specific focus is placed on the bacterial infections caused by Shigella spp., Escherichia coli, Clostridium difficile, Salmonella, and inflammatory conditions of diverticulitis and irritable bowel disease. These infectious and inflammatory diseases and their detection via molecular imaging will be compared including the appropriate differential diagnostic considerations.

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Section: Endoscopymentioning

confidence: 99%

Section: Endoscopymentioning

confidence: 99%

Imaging Inflammation and Infection in the Gastrointestinal Tract

Frickenstein

Jones

Behkam

et al. 2019

IJMS

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“…6 Because they are larger and more numerous on the left, the most common site of epiploic appendagitis is in the left lower quadrant. 7 Less frequently, the right colon is affected, and the condition mimics acute appendicitis. 6 The function of the appendages is not exactly known but is proposed to be similar to the greater omentum as a form of protection; they also may act as cushioning during peristalsis.…”

Section: Question: What Is Epiploic Appendagitis and Its Pathophysiolmentioning

confidence: 99%

It’s Not Appendicitis...? Consideration of a Benign Mimicker

Joshi¹,

Fleming²,

Spottswood

2015

Hospital Pediatrics

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Case: A previously healthy 16-year-old boy with a normal BMI presented to the emergency department with a 4-day history of severe, colicky pain in his right lower abdomen and right lower back. Before admission, while working as a cook in a restaurant, the patient reported twisting his torso and experiencing a stabbing pain on the right side of his abdomen that wrapped around to his right fl ank. The pain was so severe that he was taken by ambulance to a regional hospital. At the hospital, appendicitis was suspected, so an abdominal computed tomography (CT) scan was performed. The normal scan ruled out appendicitis and the patient was discharged with ibuprofen. However, the pain continued to worsen. Four days later, the patient arrived at this institution's pediatric emergency department and described his pain as intermittently stabbing with movement and dull and throbbing during rest. The patient reported persistent nausea and pain when bearing down but not during defecation. He had normal bowel movements with no constipation or blood, normal urine output without blood or dysuria, and reported tactile fevers. He reported no other illnesses or symptoms before or since the onset of the pain. After re-review of the original CT showing possible early changes consistent with appendicitis and persisting peritoneal signs on examination, the attending physician requested repeat abdominal CT. Question: What is appropriate imaging for evaluation of appendicitis?Per our institution's radiology protocol, ultrasound is the preferred screen for appendicitis; however, if the referring physician has a high suspicion after an equivocal study, a follow-up CT may be performed. As promoted by the Image Gently Campaign, and supported by current literature, reducing the number of abdominal/pelvic CT scans by 33% can lead to a proportionate decrease in pediatric cancers.1 Thus, ideally, ultrasound should be the fi rst imaging method used. 2,3Case Continuation: The repeat CT was read as normal by an on-call radiology fellow. The child's laboratories revealed a normal white blood cell (WBC) count 9000/µL, hematocrit 46 000/µL, erythrocyte sedimentation rate 4 mm/h, C-reactive protein 0.2 mg/L, creatinine kinase 56 IU/L, and negative porphyrins. His complete metabolic panel was normal except for mildly elevated glucose of 120 mg/dL and total bilirubin level at 1.6 mg/dL. Urinalysis was normal. The patient had decreased appetite and fl uid intake, so he was started on intravenous fl uids. He was given intravenous morphine and ondansetron for pain control and worsening nausea. Physical examination of the patient's abdomen was negative for Rovsing, Obturator, and Psoas signs positive for pain with movement, such as positional

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“…Chronic right lower quadrant pain is a clinical presentation for a spectrum of neoplastic and inflammatory diseases that may affect the ileocecal region (1,2). A variety of structures may be pathologically involved, including the cecum, appendix, ileocecal valve and/or terminal ileum; thus, clinically differentiating the source of right lower quadrant pain is challenging (2)(3)(4).…”

Section: Introductionmentioning

confidence: 99%

Potential of diffusion‑weighted imaging in magnetic resonance enterography to identify neoplasms in the ileocecal region: Use of ultra‑high b‑value diffusion‑weighted imaging

Feng

Wang

et al. 2019

Oncol Lett

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Patients with chronic inflammatory bowel disease have an increased risk of colorectal cancer, and the differentiation between neoplastic and inflammatory lesions often poses a clinical dilemma. The aim of the present study was to investigate whether diffusion-weighted (DW) magnetic resonance (MR) enterography with ultra-high b-value facilitates the identification of neoplastic lesions in the ileocecal region. A total of 76 patients (22 patients with neoplasms, 26 inflammatory lesions and 28 normal subjects) from 292 cases of suspected bowel disorders were included in the present study. All patients were examined with conventional MR enterography and DW imaging (DWI) with seven different b-values (400, 600, 800, 1,000, 1,200, 1,500 and 3,000 sec/mm 2 ) in a 3T MR scanner. DWI scans with different b-values were analyzed independently by two radiologists for the presence of ileocecal lesions. The signal intensity of the majority of inflammatory lesions and normal bowel segments gradually decreased to the background intensity with increasing b-values; however, neoplastic lesions demonstrated relative hyperintensity compared with the background. In addition, ~76% of the positive findings from b=3,000 sec/mm 2 DWI were neoplasms. In conclusion, a lesion with consistently high signal intensity from DWI images with b-values increasing to 3,000 sec/mm 2 indicated the presence of neoplasms. The results suggested that ultra-high b-value (3,000 sec/mm 2 ) imaging may aid the clinical differentiation of neoplasms from benign conditions.

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Beyond Appendicitis: Common and Uncommon Gastrointestinal Causes of Right Lower Quadrant Abdominal Pain at Multidetector CT

Cited by 67 publications

References 64 publications

Imaging Inflammation and Infection in the Gastrointestinal Tract

Imaging Inflammation and Infection in the Gastrointestinal Tract

It’s Not Appendicitis...? Consideration of a Benign Mimicker

Potential of diffusion‑weighted imaging in magnetic resonance enterography to identify neoplasms in the ileocecal region: Use of ultra‑high b‑value diffusion‑weighted imaging

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