Key findings (click on linked text):

Try to find the key findings on both axial and coronal reformats (click on "change layout" and select the two side-by-side boxes to look at both series at the same time).



• notice retrocecal appendix arising from cecal base
• Dilated, fluid-filled retrocecal appendix with several appendicoliths.
• Large area of mucosal discontinuity along the medial aspect, with extraluminal air and fluid.
• Peritoneal thickening and fluid in the right paracolic gutter.
• Few reactive ileocolic lymph nodes. 

Diagnosis: Perforated appendicitis



Case Discussion

Classic findings of perforated appendicitis, with a large area of perforation along the medial aspect evidenced by mucosal discontinuity, extraluminal fluid, and extraluminal air. This is particularly well seen on the coronal images. 

Sometimes the perforation is less obvious, and can be difficult to detect as the appendix often decompresses following perforation, and the mucosal defect can be rather subtle. In those cases, I recommend looking for extraluminal air and secondary signs of peritonitis of the adjacent structures (such as peritoneal or serosal thickening), which indicates irritation of the outer lining by enteric secretions. In this case, peritonitis is evidenced by thickening of the right paracolic gutter.