A 16-year-old boy has had crampy abdominal pain, poor appetite, and loose bowel movements for the last 2 days. Abdominal examination elicits mild tenderness in the right lower quadrant. His temperature, which was 37.2°C (99°F) yesterday, now is 37.8°C (100°F). All the 'following radiologic findings would be consistent with a diagnosis of appendicitis EXCEPT
|A||plain x-ray showing a fecalith in the right lower quadrant|
|B||plain film showing a gas-filled appendix|
|C||barium enema showing absence of appendiceal filling|
|D||barium enema showing a thin trickle of barium through a thickened terminal ileum|
a. Plain films of the abdomen, although frequently obtained as part of the general evaluation of a patient with an acute abdomen, are rarely helpful in diagnosing acute appendicitis.
b. However, plain radiographs can be of significant benefit in ruling out other pathology. In patients with acute appendicitis, one often sees an abnormal bowel gas pattern, which is a nonspecific finding.
c. The presence of a fecalith is rarely noted on plain films, but if present, is highly suggestive of the diagnosis.
d. If the appendix fills on barium enema, appendicitis is excluded. On the other hand, if the appendix does not fill, no determination can be made.
e. The findings of significance on BE include lack of filling or partial filling of the appendix and an extrinsic pressure defect on the cecum (the “reverse 3” sign).
f. Computed tomography (CT) and ultrasonography (US) are now preferred to BE in these circumstances