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Value of Bone Window Settings on CT for Revealing Appendicoliths in Patients with Appendicitis

¹ Both authors: Department of Diagnostic Radiology, William Beaumont Hospital, 3601 W. 13 Mile Rd., Royal Oak, MI 48073.

View larger version (125K): [in a new window]   Fig. 1A. —33-year-old man who presented with 2-day history of right lower quadrant pain. CT scan obtained at presentation using soft-tissue window setting was interpreted as revealing only tubular structure with wall thickening. Appendicolith (arrow) was easily mistaken for intraluminal barium. Diagnosis of appendicitis was equivocal.

View larger version (144K): [in a new window]   Fig. 1B. —33-year-old man who presented with 2-day history of right lower quadrant pain. CT scan obtained with bone window setting reveals distinct intraluminal appendicolith (arrow).

View larger version (153K): [in a new window]   Fig. 2A. —22-year-old man with pain in and guarding of right lower quadrant. CT scan obtained with soft-tissue window setting shows nonspecific inflammatory changes in right side of pelvis. Appendicolith was misinterpreted as intraluminal barium, and tubular structure (arrows) was thought to represent unopacified bowel loop.

View larger version (134K): [in a new window]   Fig. 2B. —22-year-old man with pain in and guarding of right lower quadrant. CT scan obtained with bone window setting reveals appendicolith (arrow) obstructing dilated appendix, which was source of patient's pain.

View larger version (121K): [in a new window]   Fig. 3A. —68-year-old woman who presented to emergency department with abdominal pain. CT scan obtained at presentation using soft-tissue window setting reveals only inflammatory changes (arrows) in right upper pelvis with no appendicolith.

View larger version (103K): [in a new window]   Fig. 3B. —68-year-old woman who presented to emergency department with abdominal pain. CT scan obtained using bone window setting reveals appendicolith with rim calcification (arrow) clearly distinguishable from barium and surrounding inflammation.

View larger version (112K): [in a new window]   Fig. 4A. —52-year-old woman who presented to emergency department with abdominal pain. CT scan obtained at presentation using soft-tissue window setting reveals fluid- and barium-filled loops of small bowel with no findings to support clinical diagnosis of appendicitis.

View larger version (115K): [in a new window]   Fig. 4B. —52-year-old woman who presented to emergency department with abdominal pain. Same CT image as in A obtained with bone window setting reveals dilated appendix with small proximal appendicolith (arrow) that was mistaken for barium in small-bowel loop.

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