Right-Lower-Quadrant Pain and Suspected Appendicitis in Pregnant Women: Evaluation with MR Imaging—Initial Experience

Abstract

MR imaging shows promise for evaluation of pregnant women in whom acute appendicitis is suspected by enabling diagnosis of other possible causes of right-lower-quadrant pain, including ovarian torsion or pelvic abscesses, and demonstrating a healthy or unhealthy appendix.

Evaluation of optimized inversion‐recovery fat‐suppression techniques for T2‐weighted abdominal MR imaging

“…Disease processes include inflammation, infection, and abnormal fluid collections (1)(2)(3)(4)(5)(6). T2W FS images may have particular value in pregnant patients presenting with an acute abdomen (7,8).…”

Retrocecal‐periappendicular abscess in pregnancy: diagnosis by ultrasound and magnetic resonance imaging

“…Moreover, several pathological conditions can mimic acute appendicitis 1 . Increased maternal morbidity, fetal loss, and a risk of premature delivery have been associated with delayed diagnosis (particularly in patients with complications such as perforation, peritonitis, and abscess) 1,2 and with the use of diagnostic laparotomy, including unnecessary appendectomy 3 . Ultrasound has been used in the evaluation of pregnant women with abdominal pain because it is safe, inexpensive and can be performed at the patient's side 3,4 .…”

“…Ultrasound has been used in the evaluation of pregnant women with abdominal pain because it is safe, inexpensive and can be performed at the patient's side 3,4 . The reported diagnostic accuracy of ultrasound imaging in detecting appendicitis is high in the first and second trimesters; however, during the third trimester ultrasound examination can prove technically difficult, due to the large size of the gravid uterus 2,3,5,6 . In addition, even experienced sonographers may have difficulty in detecting retrocecal appendix.…”

Emergency abdominal MRI: current uses and trends

“…Periappendiceal inflammatory changes characterized by T 2 hyperintensity within the wall and/ or the surrounding fat are best seen on fat-suppressed T 2 weighted images. 7,27 It should be noted that in the setting of pregnancy, localization of the appendix may be difficult because of enlargement of the gravid uterus causing superior and outward displacement of the caecum. This is an important consideration when trying to localize the appendix.…”

“…Air, identified as T 1 -and T 2 -hypointense foci within the collection, which may demonstrate susceptibility artefact on gradient echo imaging, is highly suspicious for abscess formation. 27 If the appendix is not identified or is normal in appearance, MRI may be useful for the detection of other pathologies as a cause for right lower quadrant pain. 6 Crohn's disease The prevalence of Crohn's disease is the highest in Europe with 322 per 100,000, followed by North America with 319 per 100,000.…”