Appendicitis: The Daily PANCE Blueprint

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Appendicitis: The Daily PANCE Blueprint

A 24-year-old man presents with 12 hours of periumbilical pain that has migrated to the right lower quadrant, along with anorexia, nausea, and a low-grade fever. He has tenderness at McBurney point with guarding and rebound. Which of the following is the most appropriate initial imaging study?

A. Abdominal radiograph
B. Right-upper-quadrant ultrasound
C. CT of the abdomen and pelvis with contrast
D. MRI of the abdomen
E. Barium enema

Answer and topic summary

The answer is C. CT of the abdomen and pelvis with contrast.

Periumbilical pain migrating to the right lower quadrant with anorexia and McBurney-point tenderness is acute appendicitis. In a non-pregnant adult, CT of the abdomen and pelvis with contrast is the best initial imaging — highly sensitive and specific (a dilated, non-filling appendix with wall thickening and fat stranding). Ultrasound is preferred first in children and pregnant patients to avoid radiation. Definitive treatment is appendectomy. Abdominal films and barium enema have no useful role here.

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Covered under ⇒ PANCE Blueprint GI and Nutrition ⇒ Small Intestine Disorders ⇒ Appendicitis

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