inflammation of mesentery

hi i'm doctor andrew dixon from radiopaedia.org and in this video we're going to look at some of the ct features ofacute appendicitis and we're going to do it by looking ataxial and coronal images from a case of a 60-year-old male presenting withright sided abdominal pain we're going to begin by looking at the coronal imagesand you can see here in the right iliac fossa that there is a blind ending tubular structure and as we follow it back we can see thatit arises from the base of the caecum consistent with it being the appendix. when we switch to the axial plane wecan see that the appendix is abnormally

distended measuring greater than sixmillimeters in diameter and the fat surrounding the appendix is abnormal.instead of appearing nice and black the fat is oedematous and has turned gray, an appearance known as fat stranding. we can compare that to region of normal intra-abdominal fat here which has anice black appearance. we can also see that there is a linear structurecoming off the appendix which is an inflamed meso-appendixwhich is often seen in the setting of appendicitis. this patient also has reactive enlargement of their mesenteric lymph nodes

which is another common finding in acuteappendicitis. importantly our patient does not haveevidence of an abscess or any locules of free gas to suggest perforation. here's a different patient showing an abscess adjacent to the tip of an inflamed appendix. this patient also has a calcified appendicolith at the base of the appendix causing the obstruction. this is a common finding in appendicitisbut is certainly not present in every case this patient also has an unrelated butit's very important pathology

demonstrated on these images. here in the left renal upper pole there is a heterogenous mass which is quite a large and is invading beyondgerota's fascia and probably getting into the left adrenal gland.this appearance is consistent with a real cell carcinoma which was an incidentalfinding his patient but obviously a very important one. so there you have it some ct features ofacute appendicitis. blind-ending, tubular structure in theright iliac fossa, arising from the base of the caecum

with thickening greater than six millimeters and surrounding inflammatory fact change. you can find out more about acuteappendicitis on the radiopaedia.org website.