The Abdominal Plain Film- AppendicitisThis is a featured page

Identifying an appendicolith can assist greatly in diagnosing appendicitis in patients presenting with acute abdominal pain. This page looks at the appendicolith and other signs of appendicitis.

  • Appendicitis is the most common infective condition that presents as an acute abdomen

  • Requires the occlusion of the appendiceal lumen by particulate material- material could be endogenously produced or foreign
  • Material could be blocking the lumen or a focus or nidus upon which faeces adhere and calcium salts are laid down

Clinical Pathway
An abdominal plain film is not considered an appropriate examination in patients with suspected appendiciis in many centres.

Plain Film Signs of Appendicitis
  • Also known as coproliths, fecaliths and stercoliths
  • Appendicoliths are common
  • Can appear in various locations with variation in location of the appendix
  • Not all appendix stones are calcified
Gas in Appendix
  • This is not necessarily a sign of appendicitis- can be seen in the normal appendix
RIF mass
  • There can be a general increase in opacity in the right lower quadrant associated with an appendiceal abscess
  • Can also be seen as bubbles of gas in the abscess
Caecal Ileus
  • Seen as dilated caecum
Flank Sign
  • Separation of the bowel from the right flank stripe by the lateral accumulation of pus and ascites
  • Reflex ileus
  • Scoliosis of lumbar spine

Case 1
The Abdominal Plain Film- Appendicitis - wikiRadiography
•21 year old male with months of RIF pain
•Increased white cell count
•Appendicolith (bottom arrow)
•A few prominent loops of small bowel.
•suggestion of a dilated caecum (top arrow)

Appendicolith (5mm) and thick-walled appendix (12mm diameter) on CT below (white arrow)
The Abdominal Plain Film- Appendicitis - wikiRadiography

Case 2
The Abdominal Plain Film- Appendicitis - wikiRadiography


•42 year old male with right sided abdominal pain
•layered appendicolith (arrowed)

•Erect AXR
•Appendicolith (white arrow)
•Fluid filled appendix with air/fluid level (black arrow)
  • ? loss of clarity of right psoas muscle

Case 3
The Abdominal Plain Film- Appendicitis - wikiRadiography

The Abdominal Plain Film- Appendicitis - wikiRadiography

42 year old female with abdominal pain
Supine AXR day 1
•loss of right psoas shadow
•Appendicolith (arrow 1)
•Distortion/medial displacement of caecal shadow
•Extraluminal gas/faeces/pus between caecum and right flank stripe- abscess (arrow 2)
•Dilated transverse colon (arrow 3)

Supine AXR day 2
  • Small bowel distention (obstruction/ileus)
•Featureless, particularly on RHS
•Appendicolith (black arrow)
•Separation of the bowel from the right flank stripe by the lateral accumulation of pus and ascites

  • dilated loop of jejunum

Case 4
Pseudo Appendicolith The arrowed structure could be mistaken for an appendicolith. It was revealed on CT to be a bony lesion in the pelvis. Not everything that looks like an appendicolith is an appendicolith!

An abdominal plain film diagnosis of appendicitis is not always possible. A significant proportion of appendicitis patients will have no plain film signs. However, when the signs of appendicitis are evident, a timely diagnosis will potentially improve patient outcomes. Importantly, the benefits of an abdominal plain film in patients with suspected appendicitis are questionable.

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Latest page update: made by AndyC , Feb 7 2010, 8:53 PM EST (about this update About This Update AndyC Moved from: Radiography - AndyC

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