ISSN: 1899-0967
Polish Journal of Radiology
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2019
vol. 84
 
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abstract:
Review paper

A pictorial essay of the most atypical variants of the vermiform appendix position in computed tomography with their possible clinical implications

Anna Zacharzewska-Gondek, Agata Szczurowska, Maciej Guziński, Marek Sąsiadek, Joanna Bladowska

© Pol J Radiol 2019; 84: e1-e8
Online publish date: 2019/01/04
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Purpose
The tip of the appendix may be located in various areas of the abdominal cavity due to its variable length and/or the changeable position of the caecum. Although in the case of an atypical position the tip is usually located behind the caecum, there are possible locations that occur very rarely. Therefore, in the case of appendicitis the symptoms may lead to the wrong diagnosis. The aim of this study is to present the most atypical locations of the tip of the appendix found on CT (computed tomography) scans and thus help to avoid misdiagnoses.

Imaging findings
The most unusual locations of the tip of the appendix found in healthy subjects included: left inferior quadrant, along the lower edge of the liver near the gallbladder and the right kidney, the tip touching the duodenum, the rectum or appendages, and a long appendix located in the scrotum as the content of a hernia. In these positions, appendicitis may mimic acute diverticulitis, cholecystitis, duodenal ulcer, duodenitis, enteritis, or adnexal or testis pathologies.

Conclusions
It is important to be aware of atypical locations of the appendix because appendicitis in an unusual area may mimic other acute abdominal diseases and delay the proper treatment.

keywords:

vermiform appendix, anatomical variants, atypical appendicitis, computed tomography

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