The Nonvisualized Appendix: Incidence of Acute Appendicitis When Secondary Inflammatory Changes Are Absent

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Abstract
OBJECTIVE. The objective of our study was to assess the importance of nonvisualization of the appendix and its association with acute appendicitis on helical CT when secondary inflammatory changes are absent.MATERIALS AND METHODS. After we received institutional review board approval, CT scans of 366 consecutive patients obtained for lower abdominal or right lower quadrant pain and to rule out appendicitis were retrospectively reviewed. Images were reviewed by an experienced abdominal radiologist and compared with the formal interpretation. The amount of right lower quadrant and pericecal fat was quantified on a scale of 0 (none) to 2 (abundant). Patients with a nonvisualized appendix and other findings compatible with acute appendicitis—such as abscess formation, localized perforation, periappendiceal fat stranding, or appendicolith—were excluded.RESULTS. The appendix could not be visualized by both reviewers in 46 (13%) of 366 cases. CT findings indicated another cause for the patient's symptoms in 12 c...