Appendicolith
Abdominal X-rays are usually normal or nonspecific in patients with appendicitis, but sometimes they can be helpful. The circled area shows a calcified structure in the expected location of the appendix consistent with an appendicolith.The term appendicolith is preferred over the less specific terms, coprolith and fecolith. Approximately 10% of patients with acute appendicitis have a radiographically visible appendicolith. One third of surgically removed appendices, however, contain an appendicolith.
The calcification may form around any type of nidus, including a piece of vegetable matter, swallowed foreign body, or even barium. The appendicolith tends to be round or oval, smooth, and laminated. The size varies, but stones in the l-2 cm range are common with stones up to 4 cm in size having been reported. The location is usually in the right lower quadrant, but the pelvis, right upper quadrant in the case of retrocecal appendix, and even the left upper quadrant may be the site.
I can't vouch for those percentages. I've seen a bunch of appendicitis but only a handful of these, and none was so obvious as this one. Maybe I need to look harder.
The CT images from the same patient reveal a dilated inflamed appendix with a calcified appendicolith.
Here's a cool ultrasound video demonstrating a similar finding.
posted by scalpel at 3:26 PM
10 Comments:
Out here in California people turn these into jewelry. They also turn cremated remains into jewelry--my massage therapist wore her Dad around her neck to the ceremony.
So the question I have is, why did you have to get a CT once you see the appendicolith? Most surgeons would operate based on that alone with a decent story.
The surgeon requested the CT, despite the presence of the appendicolith, a good story/exam, and an elevated WBC count. He'd just started another case, and it was going to be a while before he could see the patient anyway.
But it seems that more and more surgeons (and patients) are requesting preop CTs these days. I blame the third party payer system.
Cool! I love it when you post stuff like this!
Cool. I've never seen such a clear appendicolith on a radiograph. The YouTube video is no longer available. Not that I need to see what an Ac.Ax looks like on Ultrasound. I see that all the time ;o)
I know - operating non-emergently without a CT is becoming a rarer thing. I partially blame litigation fears. Surgeons feel they may get sued if the do a negative ex-lap and the patient develops a complication.
no one looks for these anymore. great job. i found one on a kid two years ago and called the surgeon and he was amazed. not surprised about california weirdos turning these into jewelry, not surprised the surgeon made you scan them.
I just arrived home form the ER, I had a CT done due to possible kidney stone pain. The doc told me that I have an appendicolith. So, do I have it removed or wait?
erp-
The real question is, why is the ER getting a plain film on a patient with a high suspicion for appendicitis? What info does it add? The surgeon's gonna make his decision to operate or get a CT regardless of whether there's an appendicolith on the plain film. It's one of those circumstances where both a negative result and a positive result prompt the same further work-up - in other words, it's unnecessary cost and radiation. Before ordering any test, no matter how seemingly innocuous, the ordering physician must ask himself, "Is there a decent chance of a result that will prompt me to change my management?". In this case the answer was most certainly, "No."
Well you think this is cool, I just had appendicitis for the second time.... laproscopically the first and a full gut job the second.... the same doctor did both surgeries... and this wasnt his first case of stump appendicitis either... apperantly it is rare....
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