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Appendicolith

Appendicolith ultrasound case study

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Uppendix Pathology

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Appendicolith ultrasound case study

Case Study Record

SN	Case Name	Report Line
1	Isolated Appendicolith	View Report Line
2	Appendicolith with Acute Appendicitis	View Report Line
3	Impacted Appendicolith with Periappendiceal Inflammation	View Report Line

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CASE–1
Isolated Appendicolith

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Clinical History

A 24-year-old patient presented with intermittent right lower abdominal discomfort without significant fever, vomiting, or marked gastrointestinal symptoms. There was no previous history of appendicitis or abdominal surgery. Clinical examination revealed mild right lower quadrant tenderness without definite peritoneal signs.

Ultrasound Findings

Ultrasound examination of the right lower quadrant demonstrates a small echogenic focus within the lumen of the appendix producing prominent posterior acoustic shadowing, consistent with an appendicolith. The appendix is not significantly dilated and does not demonstrate definite wall thickening or surrounding inflammatory fat changes. No periappendiceal fluid collection or abscess is identified. Color Doppler does not demonstrate significant increased vascularity of the appendiceal wall.

Ultrasound of the appendix. A focal echogenic structure with posterior acoustic shadowing is demonstrated within the appendiceal lumen, consistent with an appendicolith, without definite surrounding inflammatory changes.

Report Line

Focal echogenic shadowing calculus within the appendiceal lumen, consistent with an appendicolith. No definite sonographic features of acute appendicitis or periappendiceal collection identified.

Impression

Appendicolith without definite sonographic evidence of acute appendicitis.

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Recommendation

Clinical correlation is advised. If right lower quadrant pain, fever, vomiting, or other symptoms suggestive of acute appendicitis develop, repeat ultrasound or further cross-sectional imaging may be considered according to the clinical scenario.

Key Learning Points

• An appendicolith is an echogenic intraluminal appendiceal focus, commonly producing posterior acoustic shadowing.
• An appendicolith may occur without definite sonographic evidence of acute appendicitis.
• The appendix should be assessed for diameter, wall thickness, compressibility, vascularity, and surrounding inflammatory changes.
• Periappendiceal fluid or collection should be specifically assessed.
• Clinical correlation is important because the presence of an appendicolith alone does not establish acute appendicitis.

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CASE–2
Appendicolith with Acute Appendicitis

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Clinical History

A 19-year-old patient presented with right lower abdominal pain for approximately 12 hours, associated with nausea, reduced appetite, and low-grade fever. The pain had progressively localized to the right iliac fossa. On examination, there was localized tenderness over the right lower quadrant.

Ultrasound Findings

Targeted ultrasound examination demonstrates a blind-ending, non-compressible tubular structure in the right lower quadrant measuring greater than 6 mm in maximum outer diameter. An echogenic intraluminal focus with posterior acoustic shadowing is seen within the appendix, consistent with an appendicolith. The appendiceal wall appears thickened with increased vascularity on Color Doppler. Mild surrounding echogenic inflammatory fat and trace periappendiceal fluid are present. No definite drainable abscess is identified.

Ultrasound of acute appendicitis. The appendix is dilated and non-compressible with an intraluminal echogenic appendicolith producing posterior acoustic shadowing and surrounding inflammatory changes.

Color Doppler examination. Increased vascularity is demonstrated in the thickened appendiceal wall, supporting active inflammatory change.

Report Line

Blind-ending non-compressible tubular structure in the right lower quadrant measuring >6 mm in diameter, with wall thickening, increased vascularity, surrounding inflammatory changes, and an intraluminal echogenic shadowing appendicolith. Findings are consistent with acute appendicitis with appendicolith.

Impression

Sonographic features of acute appendicitis with an appendicolith. No definite periappendiceal abscess identified.

Go To Table

Recommendation

Urgent clinical and surgical correlation is recommended. The presence of an appendicolith in association with sonographic inflammatory features should be correlated with the clinical presentation and laboratory findings. Further imaging may be considered when the diagnosis remains uncertain or complications are suspected.

Key Learning Points

• An appendicolith may be an important sonographic finding in acute appendicitis.
• The inflamed appendix is typically non-compressible and enlarged.
• Increased appendiceal wall vascularity may be demonstrated on Color Doppler.
• Periappendiceal echogenic fat and fluid support surrounding inflammatory change.
• The presence of an appendicolith should prompt careful assessment for complications.
• Abscess formation, perforation, and periappendiceal fluid should be specifically evaluated.

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CASE–3
Impacted Appendicolith with Periappendiceal Inflammation

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Clinical History

A 32-year-old patient presented with severe right lower quadrant abdominal pain associated with fever, nausea, and vomiting for 2 days. The pain had progressively increased despite conservative measures. Examination demonstrated marked tenderness in the right iliac fossa.

Ultrasound Findings

Targeted ultrasound demonstrates a markedly dilated, non-compressible appendix with an echogenic intraluminal focus showing dense posterior acoustic shadowing at the appendiceal distal lumen, consistent with an impacted appendicolith. The appendiceal wall is thickened and demonstrates increased vascularity on Color Doppler. Prominent surrounding echogenic inflammatory fat, periappendiceal fluid, and localized inflammatory changes are present. No definite mature drainable abscess is demonstrated on the current examination.

Ultrasound of the appendix. A prominently echogenic shadowing focus is impacted within the appendix, associated with appendiceal dilatation, wall thickening, and surrounding inflammatory changes.

Color Doppler ultrasound. Increased vascularity is demonstrated in the inflamed appendiceal wall and adjacent inflammatory tissues.

Report Line

Markedly dilated non-compressible appendix containing an impacted echogenic shadowing appendicolith, with appendiceal wall thickening, increased vascularity, surrounding inflammatory fat and periappendiceal fluid. Findings are highly suggestive of acute appendicitis with impacted appendicolith and periappendiceal inflammatory changes.

Impression

Acute appendicitis with impacted appendicolith and significant periappendiceal inflammatory changes. No definite drainable abscess identified sonographically.

Go To Table

Recommendation

Prompt surgical consultation is recommended. Clinical and laboratory correlation is advised. If there is clinical concern for perforation, abscess formation, or other complication, further imaging such as CT may be considered according to the clinical setting.

Key Learning Points

• An impacted appendicolith may obstruct the appendiceal lumen and is associated with acute appendiceal inflammation.
• A dilated, non-compressible appendix with wall thickening is an important sonographic feature of appendicitis.
• Marked surrounding echogenic fat indicates periappendiceal inflammatory change.
• Periappendiceal fluid should be assessed carefully.
• Look specifically for complications such as abscess, perforation, extraluminal gas, or free fluid.
• Color Doppler may demonstrate increased vascularity within the inflamed appendiceal wall.
• An impacted appendicolith in a patient with acute inflammatory findings warrants prompt clinical and surgical correlation.