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MRI for Clinically Suspected Appendicitis During Pregnancy

Lodewijk P. Cobben1, Ingrid Groot2, Lucien Haans3, Johan G. Blickman4 and Julien Puylaert1

1 Department of Radiology, Medisch Centrum Haaglanden, Burgemeester Banninglaan 1, Leidschendam 2582HS, The Netherlands.
2 Department of Surgery, Medisch Centrum Haaglanden, Leidschendam 2582HS, The Netherlands.
3 Department of Obstetrics and Gynecology, Medisch Centrum Haaglanden, Leidschendam 2582HS, The Netherlands.
4 Department of Radiology, University Medical Centre Nijmegen, 6500 HB Nijmegen, The Netherlands.



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  		Fig. 1. —26-year-old woman in 11th week of pregnancy with right lower quadrant pain and clinical suspicion of appendicitis. Coronal T2-weighted image shows inflamed appendix (arrow). At base of appendix, rounded intraluminal structure without signal intensity (white arrowhead) is seen, representing appendicolith, which was confirmed by surgery and pathology. Fetus (black arrowheads) is clearly visible.

 


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  		Fig. 2A. —33-year-old woman in 13th week of pregnancy with 2 days of right lower quadrant pain and clinical suspicion of appendicitis. Coronal (A) and axial (B) T2-weighted images show enlarged appendix (white arrow) surrounded by hyperintense mass of inflamed fat (arrowheads). Enlarged uterus (black arrow, A) is also seen.

 


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  		Fig. 2B. —33-year-old woman in 13th week of pregnancy with 2 days of right lower quadrant pain and clinical suspicion of appendicitis. Coronal (A) and axial (B) T2-weighted images show enlarged appendix (white arrow) surrounded by hyperintense mass of inflamed fat (arrowheads). Enlarged uterus (black arrow, A) is also seen.

 


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  		Fig. 2C. —33-year-old woman in 13th week of pregnancy with 2 days of right lower quadrant pain and clinical suspicion of appendicitis. T2-weighted coronal fat-suppressed image clearly shows inflammatory changes around appendix (arrowheads) as areas with high signal intensity. Enlarged uterus (arrow) is also seen. Appendix itself is not clearly visible in this image.

 


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  		Fig. 2D. —33-year-old woman in 13th week of pregnancy with 2 days of right lower quadrant pain and clinical suspicion of appendicitis. Axial T1-weighted image shows inflammatory changes around appendix as low-signal-intensity mass (arrowheads). Appendix itself could not be depicted in this mass. Appendectomy was performed and nonperforated gangrenous appendix was removed. Enlarged uterus (arrow) is also seen.

 


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  		Fig. 3A. —30-year-old woman in 16th week of pregnancy with clinically suspected appendicitis. Axial T2-weighted image shows enlarged appendix (arrow); appendix is in retrocecal position.

 


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  		Fig. 3B. —30-year-old woman in 16th week of pregnancy with clinically suspected appendicitis. Axial T1-weighted image shows inflamed appendix (arrow) with some hypointense fat-stranding in surrounding fat.

 


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  		Fig. 3C. —30-year-old woman in 16th week of pregnancy with clinically suspected appendicitis. Coronal T2-weighted image shows part of inflamed appendix (white arrow) and enlarged uterus (black arrow).

 


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  		Fig. 4. —32-year-old woman in 17th week of pregnancy with right lower quadrant pain and clinically suspected appendicitis. Coronal T2-weighted image shows retrocecal normal-sized appendix (arrow) without inflammatory changes. Gravid uterus (arrowhead) is visible as well.

 

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